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The lived experience of an eating disorder among gifted female adolescents : a phenomenological study Bell, Alison J. 2004

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THE LIVED EXPERIENCE OF A N EATING DISORDER A M O N G FEMALE ADOLESCENTS: A PHENOMENOLOGICAL  GIFTED  STUDY  by A L I S O N J. B E L L B . A . , S i m o n Fraser U n i v e r s i t y , 2G01 A THESIS SUBMITTED IN P A R T I A L F U L F I L M E N T OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE F A C U L T Y OF G R A D U A T E STUDIES ( D e p a r t m e n t o f E d u c a t i o n a l and C o u n s e l l i n g P s y c h o l o g y , and S p e c i a l E d u c a t i o n )  W e accept this thesis as c o n f o r m i n g to the r e q u i r e d standard  THE UNIVERSITY OF BRITISH  COLUMBIA  A p r i l 2004  © Alison J. Bell (2004)  Library Authorization  In presenting this thesis in partial fulfillment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.  Alison J.Bell  19/04/2004  Name of Author (please print)  Date (dd/mm/yyyy)  Title of Thesis:  The Lived Experience of an Eating Disorder Among Gifted  Female Adolescents: A Phenomenological Study  Degree:  Master of Arts  Department of  Counselling Psychology  The University of British Columbia Vancouver, B C  Canada  Year:  2004  Library Authorization  In presenting this thesis in partial fulfillment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.  *  Name of Author (please print)  Title of Thesis:  A  7^)rS  L / \fecL £ x DtLf le-HOP of An Erodhint  Fheoom-ervoleJ^'t Ccx\  Degree:  H|ftS^er  Department of  S^rnck^  o£ Av^tS  ^  fLoo^SeJ 1 1 n * \  The University of British Columbia Vancouver, B C  Date'(dd/mrr/yyyy)  Canada  Y e a r :  fe^ChO'lcaM J  <J  c2QO j l  ABSTRACT A l t h o u g h several r e c o g n i z e d experts have a l l u d e d to eating disorders a m o n g gifted adolescents as an important t o p i c , it has not been e x p l o r e d t h r o u g h r i g o r o u s research m e t h o d o l o g y . D e s c r i p t i v e p h e n o m e n o l o g i c a l m e t h o d o l o g y was u s e d to p r o v i d e an i n - d e p t h d e s c r i p t i o n o f the experience, core themes, and m e a n i n g o f d i s o r d e r e d eating a m o n g gifted f e m a l e adolescents (ages 15-18). T h e research data were g a i n e d t h r o u g h i n - d e p t h i n t e r v i e w s w i t h s i x participants. A situated structure, based o n the p r e d o m i n a n t themes for each i n d i v i d u a l participant, and an in-depth d e s c r i p t i o n o f the core and c o m m o n themes o f a l l the p a r t i c i p a n t s ' experiences o f their eating disorders, were d e v e l o p e d . T h e s e core and c o m m o n themes w e r e o r g a n i z e d i n t o themes and sub-themes, each elaborated o n a n d supported t h r o u g h t h i c k d e s c r i p t i o n , i n t e r v i e w excerpts, and the w o r d s o f the participants themselves. T h e p h e n o m e n o l o g i c a l d e s c r i p t i o n o f the themes p r o v i d e d in-depth e x p l o r a t i o n o f areas p r e v i o u s l y addressed i n the relevant literature such as p e r f e c t i o n i s m , c o n t r o l , a n d l o w self-esteem. T h e m e s that address the p r o f o u n d negative affective response, e x p l i c i t c o n n e c t i o n o f giftedness to p s y c h o l o g i c a l distress, identity issues, e m o t i o n a l r e s t r i c t i o n , awareness o f m u l t i f a c e t e d u n d e r l y i n g factors, a de-emphasis o n w e i g h t a n d thinness, a n d a sense o f purpose and m e a n i n g i n the eating disorder experience represent o r i g i n a l research c o n t r i b u t i o n s that e x t e n d the current state o f k n o w l e d g e . T h e p r e v i o u s l y u n e x p l o r e d themes, and r i c h d e s c r i p t i o n o f the l i v e d e x p e r i e n c e o f an eating d i s o r d e r a m o n g gifted adolescents s i g n i f i c a n t l y contribute to c l i n i c a l practice a n d p s y c h o e d u c a t i o n i n b o t h the gifted and eating disorder fields. T h i s study benefits c l i n i c i a n s , parents, researchers, and those w h o experience eating disorders b y o f f e r i n g k n o w l e d g e o f the e x p e r i e n c e o n l y g a i n e d t h r o u g h the perspective o f those w h o struggle w i t h it p e r s o n a l l y .  TABLE OF CONTENTS  Abstract  :  Table of Contents List of Tables  iii s  Acknowledgements  CHAPTER I  ii  Introduction  vii viii  1  I n t r o d u c t i o n to the Issue  1  Statement o f the P r o b l e m and S t u d y R a t i o n a l e  7  P u r p o s e o f the S t u d y  9  C H A P T E R JJ R e v i e w o f the L i t e r a t u r e Giftedness  13 13  C o n c e p t u a l i s a t i o n s and D e f i n i t i o n s o f Giftedness  14  D e v e l o p m e n t o f G i f t e d G i r l s and Y o u n g W o m e n  18  Eating Disorders A m o n g Adolescents  19  S p e c i f i c L i t e r a t u r e - E a t i n g D i s o r d e r s A m o n g G i f t e d F e m a l e s and A d o l e s c e n t s . . . 2 2 Intellectual and C o g n i t i v e A b i l i t y R e l a t e d to E a t i n g D i s o r d e r s  27  E m p i r i c a l R e s e a r c h R e v i e w o f Giftedness and P s y c h o l o g i c a l W e l l - B e i n g  30  S e l f Esteem, Self-Concept, E m o t i o n a l Resilience and Gifted  30  Perfectionism  34  P e r f e c t i o n i s m and E a t i n g D i s o r d e r s  34  Perfectionism A m o n g Gifted  36  Q u a l i t a t i v e R e s e a r c h i n the Giftedness and E a t i n g D i s o r d e r F i e l d s Qualitative Gifted Research  40  Qualitative Research on Eating Disorders  43  T h e L i t e r a t u r e R e v i e w e d as it Relates to the C u r r e n t S t u d y  CHAPTER m  40  Methodology  R e s e a r c h Questions  46  48 49  iv  Definitions Gifted Adolescent  49 .  49  Giftedness  50  Eating Disorder  50  D e s c r i p t i v e P h e n o m e n o l o g y as a M e t h o d  50  Phenomenological Interviewing....  52  B r a c k e t i n g : R a t i o n a l e and Procedure  53  B r a c k e t i n g o f R e s e a r c h e r ' s B i a s e s and A s s u m p t i o n s : C o n s i d e r a t i o n s o f the R e s e a r c h e r as a S u b j e c t i v e P e r s o n  56  Recruitment  58  P a r t i c i p a n t S e l e c t i o n Procedures  59  Participant Characteristics  60  Informed Consent  61  I n t e r v i e w P r o c e d u r e s and the P h e n o m e n o l o g i c a l I n t e r v i e w  62  T r a n s c r i p t i o n Procedures  64  Maintenance of Confidentiality  65  Data Analysis  66  Presentation o f F i n d i n g s  72  Ethical Considerations  73  Delimitations  74  D i v e r s i t y Issues  75  V a l i d i t y and Reliability  76  C H A P T E R TV R e s u l t s  79  S i t u a t e d Structures  80  Esprit  80  Andrea  83  Phoenix  '.  88  Emily  91  Grace  96  Mary  99  V  F e e d b a c k F r o m Participants  103  G e n e r a l Structure: F i n a l T h e m e s and S u b - T h e m e s  103  T h e m e 1: N e g a t i v e A f f e c t and S e l f - P e r c e p t i o n s , E m o t i o n a l P a i n and D e t e r i o r a t i o n  105  T h e m e 2: O v e r w h e l m e d and C o n f l i c t e d  110  T h e m e 3: N o t F i t t i n g : Incongruence and A w a r e n e s s o f D i f f e r e n c e s  112  T h e m e 4: C o p i n g T h r o u g h E n g a g i n g i n the E a t i n g D i s o r d e r  114  T h e m e 5: E x p e r i e n c e o f Giftedness and E a t i n g D i s o r d e r and/or S t r u g g l e Explicitly Connected  115  T h e m e 6: P e r f e c t i o n i s m - S t r i v i n g to A t t a i n "Perfect"  117  T h e m e 7: C o n t r o l and R e s t r i c t i o n  121  T h e m e 8: A w a r e n e s s o f M u l t i f a c e t e d U n d e r l y i n g F a c t o r s  124  T h e m e 9: S a c r i f i c e , D e f i a n c e and Separation: O f Self, o f B o d y , o f N e e d s  125  T h e m e 10: A p p r e c i a t e d , P u r p o s e f u l and M e a n i n g f u l E x p e r i e n c e  CHAPTER V  Discussion  129  134  Significance o f Findings i n L i g h t of Previous Research C o n c e p t u a l i s a t i o n s o f Giftedness  134 135  S p e c i f i c Literature R e l a t e d to E a t i n g D i s o r d e r s A m o n g Gifted Adolescents  137  S o c i e t a l Pressures, S e l f - E s t e e m , P e r f e c t i o n i s m and P e r s o n a l i t y Factors  141  Interesting and U n e x p e c t e d Characteristics o f the D a t a and Participants  144  I m p l i c a t i o n o f the S t u d y and F i n d i n g s  145  :'.  Exploration o f Original Research Contributions  145  Implications F o r Psychotherapy, Psychoeducation, and E a t i n g D i s o r d e r Treatment  150  I m p l i c a t i o n s for F u t u r e R e s e a r c h  153  Strengths and L i m i t a t i o n s o f the M e t h o d o l o g y and S t u d y  155  Researcher's Subjective Experience  157  vi  References  159  A p p e n d i x A : D S M I V - R D i a g n o s t i c C r i t e r i a for E a t i n g D i s o r d e r s  169  A p p e n d i x B : I n t e r v i e w P r o t o c o l and E x a m p l e Interview Questions  171  A p p e n d i x C : R e c r u i t m e n t L e t t e r to P r o f e s s i o n a l  173  A p p e n d i x D : R e c r u i t m e n t Letter to P o t e n t i a l Participants  :  174  A p p e n d i x E : R e c r u i t m e n t A d v e r t i s i n g Poster  175  A p p e n d i x F : A d o l e s c e n t Subject C o n s e n t / A s s e n t F o r m  176  A p p e n d i x G : Subject C o n s e n t F o r m  178  A p p e n d i x H : Parental C o n s e n t F o r m  180  LIST OF TABLES T a b l e 1: T h e E x p e r i e n c e o f an E a t i n g D i s o r d e r A m o n g G i f t e d F e m a l e A d o l e s c e n t s : M a i n T h e m e s and S u b - T h e m e s  :  104  ACKNOWLEDGMENTS T h i s study c o u l d not have taken p l a c e w i t h o u t the w i l l i n g n e s s and trust o f the y o u n g w o m e n w h o v o l u n t e e r e d to share their story and parts o f w h o they are. W i t h o u t t h e m , this project w o u l d have r e m a i n e d but a t w i n k l e i n m y eye, a venture I felt was i m p o r t a n t but not a c t u a l i z e d . I thank each o f t h e m for the p r i v i l e g e o f h e a r i n g the e x p e r i e n c e they so c a n d i d l y and c o u r a g e o u s l y shared, and I hope to create s o m e t h i n g f r o m it that w i l l be w o r t h y o f the trust they gave to m e i n d o i n g so. T h e strength o f the h u m a n spirit as it endures struggle is e c h o e d i n their experiences. I w i s h t h e m a l l m u c h j o y and health i n their l i v e s . I thank D r . R i c h a r d Y o u n g , m y thesis supervisor, for his support, e n c o u r a g e m e n t and d e d i c a t i o n to assisting m e throughout this project. F r o m the i n i t i a l m u s i n g about this t o p i c , to the intensity o f the last several months, he has been w i t h m e each step o f the w a y , o f f e r i n g c h a l l e n g e s , support, and r e c o r d b r e a k i n g p r o o f r e a d i n g . H e has m e n t o r e d a c o m m i t m e n t to his students, a b e l i e f i n understanding h o w to be w i t h people, as w e l l as a strong research c o m m i t m e n t . H e is an insightful and c a r i n g m a n , as w e l l as a true a c a d e m i c , e a c h o f these aspects o f his character has benefited m e greatly. I thank b o t h D r . M a r i o n P o r a t h and D r . M a r i a A r v a y for b e i n g part o f this project as c o m m i t t e e m e m b e r s . I r e a l i z e p a r t i c i p a t i n g as c o m m i t t e e m e m b e r s o n this project w a s not a s m a l l task and they have b o t h p r o v i d e d an e n t h u s i a s m for this t o p i c f r o m the b e g i n n i n g . D r . P o r a t h has p r o v i d e d a sparkle w i t h her p o s i t i v e feedback and keen awareness a n d u n d e r s t a n d i n g o f giftedness. H e r expertise i n giftedness was a tremendous h e l p w h e n I questioned i f perhaps I was the o n l y one w h o thought this project was w o r t h w h i l e . D r . Ian D a v i s o n must be a c k n o w l e d g e d for his feedback and e d i t i n g o f this thesis. N e u r o b i o l o g y has not q u a l i f i e d h i m for this task, an extensive thesis e x p e r i e n c e o f h i s o w n ,  ix  a n d m o r e i m p o r t a n t l y a sensitive and thoughtful nature has. I also thank m y f a m i l y a n d friends for their support a n d b e l i e f i n m e . T h e ones w h o put u p w i t h m y c o m p u t e r v i g i l s , and m y n e e d to chat about this, and to also chat about real life, get e x t r a thanks. E s p e c i a l l y D r . R u s s e l l D a y w h o h a p p i l y put up w i t h m y constant presence i n his lab w h i l e p r o v i d i n g a steadfast b e l i e f i n m e as person and as an a c a d e m i c .  M a n y c l i n i c i a n s and c o l l e a g u e s also  supported m e w i t h their e n t h u s i a s m for this t o p i c , w i t h i n s i g h t f u l , and t h o u g h - p r o v o k i n g e m a i l s a n d d i s c u s s i o n s , and also a w i l l i n g n e s s to c o n s i d e r assistance i n recruitment o f the participants. F i n a l l y , I dedicate this w o r k to E v a n , m y favourite person i n the w o r l d , a little b e i n g that m a k e s e v e r y t h i n g w o r t h w h i l e . H e p r o v i d e d m u c h o f the energy to c o m p l e t e this project, as he r e m i n d e d m e d a i l y that w h o I a m as a person is m o r e important than w h a t I d o . B y r e m i n d i n g m e o f that, I was able to b r i n g w h o I a m to this project and not lose m y s e l f i n it. I thank h i m f o r his l o v e , for his spirit, for k e e p i n g m e g r o u n d e d i n the real w o r l d , a n d not c a r i n g i f I ever graduated.  1  CHAPTER I Introduction E a t i n g D i s o r d e r s pose a significant threat to the p h y s i c a l , e m o t i o n a l and p s y c h o l o g i c a l w e l l - b e i n g o f m a n y female adolescents. T h e N a t i o n a l E a t i n g D i s o r d e r s I n f o r m a t i o n C e n t r e o f C a n a d a ( N E D I C ) reports that A n o r e x i a N e r v o s a and B u l i m i a N e r v o s a affect at least 5 % o f C a n a d i a n w o m e n , t y p i c a l l y between the ages o f 14 and 3 0 ( N E D I C , 1995). D a n c y g e r and G a r f i n k e l (1995) suggest that disordered eating, w h i c h m a y not meet the f o r m a l d i a g n o s t i c requirements o f c l i n i c a l eating disorders, are 2 to 5 times m o r e l i k e l y to be d i a g n o s e d i n adolescent girls than any other group. Jones, Bennett, O l m s t e d , L a s o n and R o d i n (2001) f o u n d that i n a c o m m u n i t y based s a m p l e o f C a n a d i a n adolescents, 2 7 % o f adolescent girls b e t w e e n the ages o f 12 and 18 were f o u n d to be engaged i n d i s o r d e r e d eating attitudes and b e h a v i o u r s . O f this sample, 2 3 % o f the adolescents reported to be d i e t i n g , 1 5 % reported b i n g e eating, 8.2% reported s e l f - i n d u c e d v o m i t i n g and 2 . 4 % w e r e u s i n g diet p i l l s . O n l y 1.6% o f this s a m p l e h a d r e c e i v e d an assessment or treatment related to d i s o r d e r e d eating attitudes and/or b e h a v i o u r . These f i n d i n g s suggest that i n a d d i t i o n to the vast n u m b e r o f y o u n g C a n a d i a n w o m e n w h o are c l i n i c a l l y d i a g n o s e d w i t h an eating disorder, m a n y other y o u n g w o m e n are engaged i n and m a y be p h y s i c a l l y and p s y c h o l o g i c a l l y c o m p r o m i s e d b y d i s o r d e r e d eating attitudes and behaviours.  Introduction to the Issue D e s p i t e the vast k n o w l e d g e and o n g o i n g research c o n t r i b u t i o n s i n the eating d i s o r d e r f i e l d , e m p i r i c a l research s p e c i f i c to adolescent p o p u l a t i o n s is underrepresented (Pratt, Phillips, Greydanus & Patel, 2003).  A l t h o u g h s o m e e m p i r i c a l literature addresses e a t i n g  2  disorders a m o n g adolescent p o p u l a t i o n s , a r e v i e w o f current p u b l i s h e d literature offers n o q u a l i t a t i v e c o n t r i b u t i o n s s p e c i f i c to the experience o f eating disorders a m o n g adolescents. T h e scarcity o f qualitative eating disorder literature represents a serious gap i n o u r k n o w l e d g e base, e s p e c i a l l y g i v e n the prevalence o f these disorders. T h e gap i n the k n o w l e d g e base s p e c i f i c to gifted i n d i v i d u a l s w h o e x p e r i e n c e e a t i n g disorders is also substantial. Q u a l i t a t i v e and quantitative literature related to gifted adolescents w h o experience eating disorders is v i r t u a l l y non-existent. T h i s study a i m s to f i l l the gap i n current literature b y c o n t r i b u t i n g qualitative f i n d i n g s amongst a s a m p l e o f gifted f e m a l e adolescents. A c a d e m i c contributions f r o m the f i e l d o f both gifted e d u c a t i o n and research and eating disorders p r o v i d e the basis o f research r e v i e w e d for this study, as little specific literature p e r t a i n i n g to this t o p i c is c u r r e n t l y a v a i l a b l e . M a n y p e r s o n a l i t y and p s y c h o l o g i c a l characteristics o f adolescents have b e e n f o u n d to relate to e t i o l o g y and r i s k factors i n f l u e n c i n g the d e v e l o p m e n t o f d i s o r d e r e d eating. I n a r e v i e w o f the current literature, M u s s e l l , B i n f o r d , and F u l k e r s o n (2000) cite l o w self-esteem, p e r c e i v e d ineffectiveness, negative self-evaluation and p e r f e c t i o n i s m as p e r s o n a l i t y factors w h i c h m a y predispose an i n d i v i d u a l to disordered eating. O t h e r r e v i e w s o f the literature cite l o w self-esteem, b o d y dissatisfaction, p e r f e c t i o n i s m , h i g h ratings o f i m p o r t a n c e o f peer acceptance and l o w c o m p e t e n c e o f p h y s i c a l appearance as p r e d i s p o s i n g p e r s o n a l i t y characteristics and r i s k factors for d i s o r d e r e d eating ( G u a l , et a l . 2 0 0 2 ; L e o n , F u l k e r s o n , P e r r y , & C u d e c k , 1993; M c V e y , P e p l e r , D a v i s , Flett & A b d o l e l l , 2 0 0 2 ) . H i g h p e r s o n a l standards and p e r f e c t i o n i s m are w e l l d o c u m e n t e d i n the literature p e r t a i n i n g to eating disorders ( A s h b y & K o t t m a n , 1998; B a s t i a n i , R a o , W e l t z i n , & K a y e , 1995; Shafran & M a n s e l l , 2 0 0 1 ) . Literature also supports the h i g h i n c i d e n c e o f  3  perfectionistic tendencies a m o n g gifted adolescents ( B a k e r , 1996; G r e e n s p a n , 2 0 0 0 ; N u g e n t , 2 0 0 0 ; P a r k e r & M i l l s , 1996; S c h u l e r , 2 0 0 0 ; S i l v e r m a n , 1999). S i l v e r m a n (1999) suggests that p e r f e c t i o n i s m is the "least appreciated facet o f giftedness", and cites h o w p e r f e c t i o n i s m is an " i n e v i t a b l e " aspect o f giftedness and "needs to be appreciated as a t w o - e d g e d s w o r d that has potential for p r o p e l l i n g an i n d i v i d u a l t o w a r d u n p a r a l l e l e d greatness or p l u m m e t i n g one into despair" (p. 2 1 6 ) . It c a n be i n d u c e d that p s y c h o s o c i a l and personality factors o f gifted f e m a l e adolescents o v e r l a p w i t h risk factors for d i s o r d e r e d eating. A d o l e s c e n t females w h o are gifted h a v e been f o u n d to have l o w e r s o c i a l and total self-esteem, m o r e s i g n i f i c a n t decreases i n self-esteem, decreased levels o f self-confidence and self-regard and i n c r e a s e d l e v e l s o f p e r f e c t i o n i s m , hopelessness and discouragement w h e n c o m p a r e d to " n o n - g i f t e d " f e m a l e adolescents ( K l e i n & Z e h m s , 1996; K l i n e & Short, 1991; L e a - W o o d & C l u n i e - R o s s , 1995). O f f e r i n g another perspective, H o g e and R e n z u l l i (1993) f o u n d little difference b e t w e e n the general self-concept o f gifted and non-gifted c h i l d r e n . O v e r the last several decades, studies i n v e s t i g a t i n g the i n t e l l e c t u a l f u n c t i o n i n g o f adolescents e x p e r i e n c i n g c l i n i c a l l y d i a g n o s e d eating disorders have y i e l d e d c o n t r a d i c t o r y results. O v e r a l l , i n t e l l e c t u a l performance a m o n g those d i a g n o s e d w i t h eating disorders has been f o u n d to be representative o f a n o r m a l d i s t r i b u t i o n ( D u r a & B o r n s t e i n , 1989; G U l b e r g , G i l l b e r g , R a s t a m & Johansson, 1996; R a n s e e n & H u m p h r i e s , 1992). In a r e v i e w o f this literature, B l a n z , D e t z n e r , L a y , R o s e and S c h m i d t (1997), address the d i s p a r i t y b e t w e e n results o f these studies and the c o m m o n c l i n i c a l observation o f h i g h i n t e l l e c t u a l f u n c t i o n i n g a m o n g adolescents d i a g n o s e d w i t h eating disorders. S h o r t c o m i n g s o f p r e v i o u s studies are noted, and subsequent f i n d i n g s suggest that, w h e n c o m p a r e d to a m a t c h e d c o n t r o l g r o u p , the  4  I Q s o f the "patients" d i a g n o s e d w i t h eating disorders were s i g n i f i c a n t l y h i g h e r than those o f the patients i n the c o n t r o l group. A p o s i t i v e c o r r e l a t i o n , w h i c h was w e a k yet s i g n i f i c a n t , was f o u n d b e t w e e n w e i g h t loss before h o s p i t a l i z a t i o n and i n t e l l i g e n c e . T h e authors suggest that there m a y be a r e l a t i o n s h i p and i n f l u e n c e between h i g h i n t e l l i g e n c e , a c h i e v e m e n t m o t i v a t i o n , and a b i l i t y to s u c c e s s f u l l y lose w e i g h t . It is suggested that further studies are necessary to investigate this r e l a t i o n s h i p ( B l a n z et a l . , 1997). T h e studies r e l a t i n g to the i n t e l l e c t u a l f u n c t i o n i n g o f i n d i v i d u a l s e x p e r i e n c i n g eating disorders p r o v i d e an important l i n k to the experience o f d i s o r d e r e d eating a m o n g gifted adolescents and to the c o n c e p t u a l i s a t i o n o f "giftedness" itself. T r a d i t i o n a l l y giftedness has been c o n c e p t u a l i s e d and d e f i n e d b y h i g h I Q ( I Q above 130 or 2 standard d e v i a t i o n s a b o v e the n o r m o n standardized i n t e l l i g e n c e tests) ( R e n z u l l i , 2 0 0 2 ) . O v e r recent years, theorists have c o n t r i b u t e d v a r i o u s conceptualisations o f i n t e l l i g e n c e related to giftedness (e.g., R a m o s F o r d & G a r n e r , 1997; Sternberg, 1997; Sternberg, 2 0 0 3 ; H o g e & R e n z u l l i , 1993; R e n z u l l i , 2 0 0 2 ) . T h u s the d e f i n i t i o n o f " g i f t e d " continues to e v o l v e and to r e m a i n c o n t r o v e r s i a l . J a c k s o n (1995) refers to m a n y o f the c o m m o n characteristics, w h i c h m a y differentiate gifted individuals: A d v a n c e d c o m p r e h e n s i o n , u n u s u a l retentiveness, accelerated thought processes, u n u s u a l s e n s i t i v i t y to the expectations and feelings o f others, a sense o f b e i n g different, a need for j u s t i c e , perfectionistic tendencies and u n e v e n d e v e l o p m e n t o f i n t e l l e c t u a l , e m o t i o n a l and p h y s i c a l d o m a i n s , (p. 33)  S i l v e r m a n (1998) also refers to the " u n e v e n " or " a s y n c h r o n o u s d e v e l o p m e n t " o f gifted i n d i v i d u a l s a n d suggests: A s y n c h r o n o u s d e v e l o p m e n t is an attempt to understand the p h e n o m e n o n  5  [giftedness] through the lens o f the gifted self, rather than the perspective o f society [and] h i g h l i g h t s the c o m p l e x i t y o f the i n d i v i d u a l ' s thought processes, the intensity o f sensation, e m o t i o n , and i m a g i n a t i o n , and the extraordinary awareness that results f r o m this fusion. ( D e f i n i t i o n s o f Giftedness S e c t i o n , H 4)  T o reflect and respect the n o t i o n o f asynchronous d e v e l o p m e n t a m o n g gifted adolescents, one d e f i n i t i o n o f giftedness used w i l l be that o f the C o l u m b u s G r o u p : " G i f t e d n e s s " is asynchronous d e v e l o p m e n t i n w h i c h a d v a n c e d c o g n i t i v e a b i l i t i e s and heightened intensity c o m b i n e to create inner experiences and awareness that are q u a l i t a t i v e l y different f r o m the n o r m . T h i s a s y n c h r o n y increases w i t h higher intellectual capacity. T h e uniqueness o f the gifted renders t h e m p a r t i c u l a r l y vulnerable and requires m o d i f i c a t i o n s i n parenting, t e a c h i n g and c o u n s e l i n g i n order for t h e m to d e v e l o p o p t i m a l l y . ( C o l u m b u s G r o u p , 1991 as c i t e d i n J a c k s o n , 1995; S i l v e r m a n , 1998, D e f i n i t i o n s o f Giftedness S e c t i o n , % 4)  T h i s d e f i n i t i o n o f giftedness and its reference to a s y n c h r o n o u s d e v e l o p m e n t reflect w e l l the n o t i o n o f gifted adolescents b e i n g out o f step w i t h i n themselves, and also w i t h their peers.  D e v e l o p m e n t a l potential and p s y c h i c o v e r e x c i t a b i l i t i e s are also salient to the  experience and i d e n t i f i c a t i o n o f giftedness.  D e v e l o p m e n t a l potential is d e f i n e d as "the  i n d i v i d u a l ' s c o n s t e l l a t i o n o f talents, special abilities, and i n t e l l i g e n c e , p l u s the f i v e w a y s o f p r o c e s s i n g the data o f e x p e r i e n c e " (Introduction S e c t i o n , f 2). T h e f i v e w a y s o f p r o c e s s i n g refer to w h a t are d e f i n e d as p s y c h o m o t o r , sensual, i n t e l l e c t u a l , i m a g i n a t i o n a l a n d e m o t i o n a l o v e r e x c i t a b i l i t i e s ( P i e c h o w s k i , 1997; P i e c h o w s k i & M i l l e r , 1995). O v e r e x c i t a b i l i t i e s and the  6  associated intensity or heightened experience are also v i e w e d as important i n the d e v e l o p m e n t and i d e n t i f i c a t i o n o f giftedness, and this is also reflected w e l l i n the c h o s e n operational d e f i n i t i o n o f this study ( A c k e r m a n & P a u l u s , 1997; J a c k s o n , 1995; P i e c h o w s k i & M i l l e r , 1995; P i e c h o w s k i & C o l a n g e l o 1984; P i e c h o w s k i , 1997). T h e B . C M i n i s t r y o f E d u c a t i o n guidelines (2002) consider a student gifted w h e n : she/he possesses demonstrated or potential abilities that g i v e e v i d e n c e o f e x c e p t i o n a l l y h i g h c a p a b i l i t y w i t h respect to intellect, c r e a t i v i t y or the s k i l l s associated w i t h specific d i s c i p l i n e s . Students w h o are gifted often demonstrate outstanding abilities i n m o r e than one area. T h e y m a y demonstrate e x t r a o r d i n a r y intensity o f focus i n their particular areas o f talent or interest. (Identification and A s s e s s m e n t S e c t i o n , f 2) It is suggested that n o s i n g l e c r i t e r i o n s h o u l d be u s e d i n the i d e n t i f i c a t i o n o f gifted students a n d that m u l t i p l e c r i t e r i a and sources o f i d e n t i f i c a t i o n s h o u l d be u t i l i z e d . It is suggested that c r i t e r i a s h o u l d i n c l u d e several o f the f o l l o w i n g : T e a c h e r observations i n c l u d i n g anecdotal records, c h e c k l i s t s a n d i n v e n t o r i e s ; records o f student a c h i e v e m e n t i n c l u d i n g assignments, p o r t f o l i o s , grades and outstanding talents, interests and a c c o m p l i s h m e n t s ; n o m i n a t i o n b y educators, parents, peers and/or self; i n t e r v i e w s o f parents and students; and f o r m a l assessments to l e v e l C o f c o g n i t i v e a b i l i t y , achievement, aptitude and creativity. ( B . C . M i n i s t r y o f E d u c a t i o n , 2 0 0 2 ; Identification and A s s e s s m e n t S e c t i o n , f 2)  7  Statement of the Problem and Study Rationale F e w studies refer s p e c i f i c a l l y to d i s o r d e r e d eating a m o n g gifted females a l t h o u g h the existence o f the p h e n o m e n o n is a l l u d e d to i n v a r i o u s p u b l i c a t i o n s (e.g., J a c k s o n & Peterson, 2 0 0 3 ; J o h n s t o n , 1996; K e r r , 2 0 0 0 ; K e r r & N i c p o n , 2 0 0 3 ; N u g e n t , 2 0 0 0 , Peterson, 1998; S i l v e r m a n , 1994). D i f f e r e n t i a t i n g characteristics o f gifted i n d i v i d u a l s suggested b y J a c k s o n (1995) also reflect m a n y o f the r i s k factors associated w i t h d i s o r d e r e d eating. J a c k s o n and Peterson (2003) suggest that w i t h o u t appropriate support gifted adolescents m a y be p r o n e to " a n x i e t y states, depressive disorder, eating disorders, and o b s e s s i v e - c o m p u l s i v e b e h a v i o r s " (p. 177). G a t t o - W a l d e n (1999) reflects o n her c l i n i c a l experience c o u n s e l l i n g gifted w o m e n and female adolescents e x p e r i e n c i n g disordered eating. S h e suggests that a m o n g gifted clients s t r u g g l i n g w i t h disordered eating, several characteristics are c o m m o n . T h e s e characteristics i n c l u d e : "personal identity that has d i s o w n e d b e i n g gifted, d e b i l i t a t i n g . p e r f e c t i o n i s m , e x c e s s i v e need to please others, experience o f i s o l a t i o n a n d l o n e l i n e s s , stressful t r a n s i t i o n d u r i n g the onset o f the disorder and f a m i l y d y n a m i c s w h i c h m a y i n c l u d e : o v e r p r o t e c t i o n , enmeshment, perfectionistic f a m i l y standards and abuse or a d d i c t i v e b e h a v i o u r " (p. 119). G a r n e r (1991), an i n f l u e n t i a l researcher i n the f i e l d o f d i s o r d e r e d eating, addresses the "nature and scope o f the p r o b l e m " o f disordered eating a m o n g gifted adolescents.  Garner  suggests that "potential p r e d i s p o s i n g factors...seem p a r t i c u l a r l y relevant to those w h o m a y be i d e n t i f i e d as g i f t e d . . . " (p. 52). G a r n e r (1991) asserts that gifted adolescents " m a y be m o r e v u l n e r a b l e to the d e v e l o p m e n t o f b o t h a n o r e x i a n e r v o s a and b u l i m i a n e r v o s a because [they] possess m a n y traits that have been i d e n t i f i e d as r i s k factors for eating d i s o r d e r s " (p. 6 1 ) . G a r n e r describes a n u m b e r o f p o s s i b l e factors i n f l u e n c i n g the d e v e l o p m e n t o f e a t i n g  8  disorders a m o n g gifted adolescents, w h i c h i n c l u d e : c o m p e t i t i v e settings, w e i g h t loss as "another area for d i s p l a y i n g personal c o m p e t e n c e " , l o w self esteem, p e r f e c t i o n i s m , interactional and f a m i l y patterns and educational programs w h i c h focus o n p e r f o r m a n c e , p e r s o n a l mastery, and v o c a t i o n , p o s s i b l y n e g l e c t i n g other important areas o f female p s y c h o l o g i c a l d e v e l o p m e n t (p. 53). B a s e d o n a r e v i e w o f e m p i r i c a l literature, N i e h a r t (1999) asserts, "It is clear that giftedness influences the p s y c h o l o g i c a l w e l l - b e i n g o f i n d i v i d u a l s " (Introduction s e c t i o n , 11). W h e t h e r giftedness contributes to p s y c h o l o g i c a l f u n c t i o n i n g i n a p o s i t i v e o r negative w a y continues to be a matter o f debate. H o w giftedness affects p s y c h o l o g i c a l f u n c t i o n i n g m a y be l a r g e l y dependent o n v a r i o u s factors, i n c l u d i n g the u n i q u e characteristics o f gifted i n d i v i d u a l s and their e n v i r o n m e n t . It is not m y i n t e n t i o n to argue that gifted adolescents are m o r e v u l n e r a b l e to p s y c h o l o g i c a l d y s f u n c t i o n , although giftedness i n e v i t a b l y affects i n d i v i d u a l s i n a v a r i e t y o f w a y s and i n m a n y aspects o f their l i v e d experience. It is not m y i n t e n t i o n to argue that a l l adolescents w h o experience disordered eating are gifted. S u c h an a s s u m p t i o n w o u l d m o s t c e r t a i n l y be a gross o v e r g e n e r a l i z a t i o n . It is also not m y intention to relate a l l o f the characteristics o f gifted adolescents to the d e v e l o p m e n t o f d i s o r d e r e d eating, a l t h o u g h s o m e o f the features o f giftedness m a y be c o n c e p t u a l i s e d as p r e d i s p o s i n g or as p o s i n g r i s k factors related to the d e v e l o p m e n t o f disordered eating for adolescent females (i.e. p e r f e c t i o n i s t i c tendencies, l o w self esteem, u n u s u a l s e n s i t i v i t y to the expectations a n d feelings o f others, decreased l e v e l s o f self-confidence and self-regard, c o m p e t i t i v e n e s s , etc.). It is m y i n t e n t i o n to investigate and describe the l i v e d experience, m e a n i n g and core and c o m m o n themes o f d i s o r d e r e d eating a m o n g a s a m p l e o f gifted female adolescents.  9  A d o l e s c e n t s w h o are gifted m a y articulate the experience o f d i s o r d e r e d eating i n a u n i q u e w a y , a n d their " d e v e l o p m e n t a l p o t e n t i a l " and " o v e r e x c i t a b i l i t i e s " m a y be articulated t h r o u g h the c o n s t r u c t i o n o f m e a n i n g i n their l i v e d experiences. T h i s bias was c a r e f u l l y b r a c k e t e d p r i o r to i n t e r v i e w i n g and data analysis, as were a l l other p e r s o n a l reflections and beliefs r e g a r d i n g d i s o r d e r e d eating, p a r t i c u l a r l y a m o n g this p o p u l a t i o n . T h e p r o b l e m addressed was: W h a t is the l i v e d experience and m e a n i n g o f d i s o r d e r e d eating a m o n g gifted female adolescents?  I sought to e x p l o r e this p h e n o m e n o n i n an in-depth m a n n e r a n d to  describe the core and c o m m o n themes o f the l i v e d experience o f d i s o r d e r e d eating for gifted adolescent females. T h e p h e n o m e n o n w i l l be presented through the vantage p o i n t o f the p a r t i c i p a n t s ' p e r s o n a l experience and e v e r y attempt was m a d e to describe their e x p e r i e n c e w h i l e r e m a i n i n g faithful to c o m m u n i c a t i o n o f their stories as s u b j e c t i v e l y e x p e r i e n c e d b y t h e m . It is important to note that the study and f i n d i n g s are situated i n a p a r t i c u l a r s o c i a l context and western culture.  Purpose of the Study " A s k anyone w h o manages a secondary l e v e l gifted p r o g r a m about eating disorders and they w i l l u n d o u b t e d l y say that it is a serious c o n c e r n . " (Peterson, 1998, p . 197) T h e purpose o f this study was to e x p l o r e the experience o f eating disorders a m o n g a s a m p l e o f gifted female adolescents. T h e m e a n i n g that the participants a s c r i b e d to the e x p e r i e n c e o f h a v i n g an eating disorder, and the core and c o m m o n themes i n their e x p e r i e n c e was e x p l o r e d and d e s c r i b e d .  10  M y c l i n i c a l experience w o r k i n g w i t h y o u n g w o m e n s t r u g g l i n g w i t h d i s o r d e r e d eating i n an outpatient m e n t a l health setting has c o n f i r m e d m y b e l i e f that eating disorders p o s e a l i f e - a l t e r i n g struggle, f i l l e d w i t h e m o t i o n a l p a i n , and s e l f - e x a m i n a t i o n . I a m c o n t i n u a l l y i n a w e o f the maturity, insight, determination and r e s i l i e n c e o f some o f m y c l i e n t s despite their d a i l y struggle w i t h their eating disorder and attempts to c h a l l e n g e d the u n d e r l y i n g c o n t r i b u t i n g factors. D i s o r d e r e d eating for any adolescent is a c o m p l e x and i n h e r e n t l y e n i g m a t i c e x p e r i e n c e that m a y not be captured f u l l y w i t h i n a quantitative p a r a d i g m . T h i s study sought to contribute k n o w l e d g e to the f i e l d o f eating disorders w i t h research that is c l o s e to the h u m a n e x p e r i e n c e o f the participants. T h e C o l u m b u s group d e f i n i t i o n o f giftedness e m p h a s i z e s m a n y o f the u n i q u e characteristics o f gifted i n d i v i d u a l s : " A d v a n c e d c o g n i t i v e abilities and heightened intensity c o m b i n e to create inner experiences and awareness that are q u a l i t a t i v e l y different f r o m the n o r m . . . " ( C o l u m b u s G r o u p , 1991 as c i t e d i n S i l v e r m a n , 1998, D e f i n i t i o n s o f G i f t e d n e s s S e c t i o n , 14).  I f the experiences and awareness o f gifted adolescents are q u a l i t a t i v e l y  different f r o m the n o r m , a d e s c r i p t i o n and e x p l o r a t i o n o f this subjective e x p e r i e n c e a n d the associated m e a n i n g is v a l u a b l e . U n f o r t u n a t e l y this study w i l l not p r o v i d e c o m p a r i s o n to a "non-gifted" population. T h e p r e v a l e n c e and presentation o f eating disorders a m o n g gifted adolescent females are u n k n o w n , despite b e i n g d i s c u s s e d or suggested i n several p u b l i c a t i o n s ( G a r n e r , 1 9 9 1 ; G a t t o - W a l d e n , 1999; N i e h a r t , 1999; N u g e n t , 2 0 0 0 ; Peterson, 1998; S i l v e r m a n , 1994). T h e l a c k o f research i n this area, despite its reference i n the literature, represents a gap i n a c a d e m i c and c l i n i c a l k n o w l e d g e . In f i l l i n g this gap w i t h a p h e n o m e n o l o g i c a l i n q u i r y , a d e s c r i p t i o n o f the l i v e d experience m a y be g a i n e d f r o m the participants. A d o l e s c e n t s  11  w h o s e e m o t i o n a l and c o g n i t i v e d e v e l o p m e n t m a y be c o n s i d e r e d " a d v a n c e d " m a y articulate their e x p e r i e n c e i n a m a n n e r that is also advanced, and that p o s s i b i l i t y a l l o w s for c o n s i d e r a t i o n o f its relevance to non-gifted adolescents. T h i s study c a n be c o n s i d e r e d one o f d i s c o v e r y a n d d e s c r i p t i o n . L i t e r a t u r e r e l a t i n g to eating disorders and also gifted i d e n t i f i c a t i o n and d e v e l o p m e n t , addresses the need f o r q u a l i t a t i v e data to p r o v i d e the l e v e l o f depth and m e a n i n g associated w i t h u n d e r s t a n d i n g l i v e d e x p e r i e n c e ( C o l e m a n & C r o s s , 2 0 0 0 ; Garrett, 1997; H o s k i n s , 2 0 0 2 ; K u n k e l & C h a p a 1992; M a t o f f & M a t o f f , 2 0 0 1 ) . K u n k e l and C h a p a (1992) refer to the essential nature o f research that focuses o n gifted experience. M a t o f f and M a t o f f (2001) assert that the process a n d e x p e r i e n c e o f d i s o r d e r e d eating and r e c o v e r y f r o m a c l i e n t ' s account "has p o t e n t i a l to be a r i c h source o f untapped i n f o r m a t i o n . . . " (p. 44).  H o s k i n s (2002) notes that despite  substantial research attention i n v o l v i n g eating disorders, " a n in-depth u n d e r s t a n d i n g o f the c o m p l e x i t y o f this d i s o r d e r has fallen short i n m a n y w a y s " based o n t r a d i t i o n a l m e t h o d s o f i n q u i r y (p. 2 3 1 ) . H o s k i n s (2002) also suggests this s h o r t c o m i n g and a focus o n i n d i v i d u a l p a t h o l o g y h a v e " n e g l e c t e d to truly understand the l i f e w o r l d s o f girls i n c o n t e m p o r a r y s o c i e t y " (p. 2 3 2 ) . Garrett (1997) refers to the m a n y aspects o f the e x p e r i e n c e o f eating disorders that cannot or are not t h o r o u g h l y e x a m i n e d through quantitative means and argues that there exists a l a c k o f indicators o f p o s i t i v e outcomes and r e c o v e r y i n current research. T h e s e i n d i c a t o r s o f r e c o v e r y m a y o n l y be e l i c i t e d b y the stories o f those e x p e r i e n c i n g a n d r e c o v e r i n g f r o m eating disorders (Garrett, 1997). C o l e m a n and C r o s s (2000) c a l l for research that addresses the p e r s o n a l , l i v e d experiences o f gifted i n d i v i d u a l s and describe the u n d e r t a k i n g o f s u c h research as a " p o t e n t i a l l y fruitful area" (p. 208). C o l e m a n and C r o s s s p e c i f i c a l l y identify research s u c h as  12  phenomenology, which may explore social and emotional factors, meaning and understanding of experience among gifted individuals, as valuable and underrepresented in gifted literature. A re-emphasis of the Columbus group definition of gifted accentuates the importance of appreciating the unique qualities of gifted individuals and consideration of those qualities in counselling and educational settings. M y own understanding of this phenomenon w i l l be deepened and my clinical knowledge broadened. Through presentation of these research findings, this may also be the case for other professionals working within the academic or clinical realms of gifted or eating disorder counselling, treatment, prevention and education. Individuals who struggle with disordered eating, perhaps gifted and non-gifted, and others whose lives are touched by the experience may find the results offer new insight, or that parts of the participants' experience resonate with them. The participants of this study have given of themselves by sharing their story, many with the hopes of helping someone else or contributing knowledge that they also seem to feel is lacking. The potential for this research to impact some or many, fueled its inception and allowed it to come forth.  13 C H A P T E R II Review of the Literature  A s m e n t i o n e d , the current literature p e r t a i n i n g to eating disorders a m o n g gifted adolescents is not w e l l d e v e l o p e d . T o p r o v i d e a s o l i d f o u n d a t i o n for the ideas e x p l o r e d i n this thesis, the literature that does exist is addressed and is also s u p p l e m e n t e d b y other areas o f research i n the eating disorder and giftedness fields. T h i s r e v i e w e x p l o r e s the t o p i c s o f giftedness, its conceptualisations and definitions i n current literature, d e v e l o p m e n t o f gifted adolescents a n d y o u n g w o m e n , and eating disorders a m o n g adolescents. It also h i g h l i g h t s s o c i o c u l t u r a l , e t i o l o g i c a l and r i s k factors related to eating disorders c i t e d i n literature r e v i e w s , a n d i n t e l l e c t u a l and c o g n i t i v e a b i l i t y as it relates to eating d i s o r d e r p o p u l a t i o n s . P e r f e c t i o n i s m and p s y c h o s o c i a l variables, p r i m a r i l y self-esteem and self-concept, are elaborated o n as they are seen as o v e r l a p p i n g themes frequently c i t e d i n literature relevant to b o t h gifted a n d eating disorder p o p u l a t i o n s . A s a m p l e o f qualitative research i n b o t h fields, w h i c h addresses the experience o f giftedness, giftedness as it relates to the e x p e r i e n c e o f depression a m o n g gifted adolescents, and the experience o f eating disorders are o u t l i n e d .  Giftedness T h e f i e l d o f gifted education and research is vast a n d the a m o u n t o f literature addressing the d e f i n i t i o n s and conceptualisations o f v a r i o u s forms o f giftedness a n d its a p p l i c a t i o n to research is o v e r w h e l m i n g . In an attempt to l a y sufficient g r o u n d w o r k for the purposes o f this research study, I have i n c o r p o r a t e d a s a m p l e o f current and relevant literature that addresses the f i e l d o f giftedness. I g i v e p a r t i c u l a r emphasis to the d i f f i c u l t y i n  14  c o n c r e t e l y d e f i n i n g gifted, e x a m p l e s o f multifaceted approaches to d e f i n i n g giftedness, a n d gender a n d female d e v e l o p m e n t a m o n g gifted p o p u l a t i o n s .  Conceptualisations and Definitions of Giftedness H o g e a n d R e n z u l l i (1993) address the " c o n t r o v e r s i e s " and " a m b i g u i t i e s " i n d e f i n i n g the construct o f giftedness, its measurement, and the various w a y s that it m a y be c o n c e p t u a l i s e d (p. 4 5 0 ) . M o r e l o c k (1996) also refers to the controversies i n d e f i n i n g giftedness and the w a y s i n w h i c h research is affected amidst the "morass o f c o n f u s i o n " (Introduction section, 11).  T h e d i f f i c u l t y i n a n a l y z i n g and c o n d u c t i n g research i n the f i e l d o f  giftedness poses m a n y d i l e m m a s as suggested b y H o g e and R e n z u l l i , due to the disagreement and v a r i o u s w a y s i n w h i c h the construct m a y be a p p l i e d i n research studies. T h e y e m p h a s i z e the v a r i a b i l i t y i n h o w the construct o f giftedness is defined and o p e r a t i o n a l i s e d n o t i n g that i n some instances it is n a r r o w , for e x a m p l e o n l y c o n s i d e r i n g " h i g h l y e x c e p t i o n a l i n t e l l e c t u a l capacities", and i n others m o r e broad, c o n s i d e r i n g " i n t e l l e c t u a l , m o t i v a t i o n a l and artistic d i m e n s i o n s " (p. 4 5 0 ) . T h e variety o f objective and subjective w a y s i n w h i c h n a r r o w a n d b r o a d d e f i n i t i o n s are measured is also noted as c o n t r i b u t i n g to the d i f f i c u l t i e s i n s t u d y i n g giftedness. R e n z u l l i (2002) describes "past and present definitions o f giftedness" w i t h a s u r v e y o f " c o n s e r v a t i v e " to " l i b e r a l " definitions o f giftedness (p. 67). R e n z u l l i considers l i b e r a l d e f i n i t i o n s o f giftedness, such as those that o n l y c o n s i d e r h i g h I Q , to be restrictive and less consistent w i t h current approaches to c o n c e p t u a l i s i n g i n t e l l i g e n c e and giftedness, s u c h as those p r o p o s e d b y Sternberg (1997, as c i t e d i n R e n z u l l i , 2002), G a r d n e r (1983 as c i t e d i n R e n z u l l i , 2 0 0 2 ) , or R e n z u l l i (1978 as c i t e d i n R e n z u l l i , 2002). D e f i n i t i o n s a n d  15  c o n c e p t u a l i s a t i o n s o f giftedness such as these are seen as m u l t i f a c e t e d and to take into account v a r i o u s forms o f i n t e l l i g e n c e . R e n z u l l i (2002) suggests that n o s i n g l e c r i t e r i o n s h o u l d be u s e d to classify giftedness, although he notes that i n general, groups o f traits s u c h as a b o v e average a b i l i t y (both general and specific), task c o m m i t m e n t , and c r e a t i v i t y are possessed b y gifted i n d i v i d u a l s . R e n z u l l i refers to this n o t i o n o f giftedness as the 3 - r i n g c o n c e p t i o n o f giftedness. A b r i e f g l i m p s e o f other multifaceted, and less restrictive c o n c e p t u a l i s a t i o n s o f giftedness s u c h as those p r o p o s e d b y Sternberg (1997, 2 0 0 3 ) , R a m o s - F o r d a n d G a r d n e r (1997), a n d V o n K a r o l y i , R a m o s - F o r d and G a r d n e r (2003), p r o v i d e further, less c o n s e r v a t i v e d e f i n i t i o n s , and propose c o n s i d e r a t i o n o f v a r i o u s forms o f i n t e l l i g e n c e . S t e r n b e r g ( 1 9 9 7 , 2 0 0 3 ) also suggest that i d e n t i f i c a t i o n o f giftedness must take into account v a r i o u s f o r m s o f i n t e l l i g e n c e , o t h e r w i s e v a r i o u s forms o f giftedness or gifted i n d i v i d u a l s m a y be o v e r l o o k e d b y this c l a s s i f i c a t i o n . Sternberg's (1997, 2003) triarchic v i e w o f giftedness c o n s i d e r s a n a l y t i c a l , synthetic and p r a c t i c a l giftedness. A n a l y t i c a l giftedness relates to p r o b l e m s o l v i n g and r e a s o n i n g and is the aspect o f giftedness m o s t r e a d i l y m e a s u r e d b y s t a n d a r d i z e d i n t e l l i g e n c e tests. .Synthetic or creative giftedness is seen as p r o m i n e n t i n i n d i v i d u a l s w h o are " i n s i g h t f u l , i n t u i t i v e , creative, or just p l a i n adept at c o p i n g w i t h r e l a t i v e l y n o v e l s i t u a t i o n s " and is less e a s i l y measured through standardized tests (Sternberg, 1997, p . 4 4 ) . P r a c t i c a l giftedness i n v o l v e s the w a y i n w h i c h an i n d i v i d u a l p r a g m a t i c a l l y applies a n a l y t i c a n d synthetic a b i l i t i e s . V o n K a r o l y i , R a m o s - F o r d and G a r d n e r (2003) refer to i n t e l l i g e n c e and giftedness as m u l t i p l e i n nature. T h e c o m p l e x i t y and variety i n m u l t i p l e i n t e l l i g e n c e s c o n t i n u e to e v o l v e and c h a l l e n g e notions o f i n t e l l i g e n c e measured b y i n t e l l e c t u a l l y f o c u s e d measures. V o n  16  K a r o l y i , R a m o s - F o r d and G a r d n e r (2003) identify eight m u l t i p l e intelligences w h i c h i n c l u d e : 1) l i n g u i s t i c , 2) l o g i c a l - m a t h e m a t i c a l , 3) m u s i c a l , 4) spatial, 5) b o d i l y - k i n e s t h e t i c , 6) interpersonal, 7) intrapersonal, and 8) naturalistic. A n i n t h i n t e l l i g e n c e , w h i c h is b e i n g v a l i d a t e d and e x p l o r e d , is existential intelligence and is defined as "an interest and c o n c e r n w i t h ' u l t i m a t e i s s u e s ' " a n d " p o n d e r i n g the fundamental questions o f e x i s t e n c e " (p. 102). T h e e x i s t e n t i a l i n t e l l i g e n c e o u t l i n e d here seems to fit w e l l w i t h conceptualisations o f giftedness that i n c l u d e o v e r e x c i t a b i l i t i e s and the propensity o f gifted i n d i v i d u a l s to e x p e r i e n c e existential depression (e.g. J a c k s o n , 1995; J a c k s o n & Peterson, 2 0 0 3 ) or s p i r i t u a l giftedness as d e s c r i b e d b y P i e c h o w s k i (2003). V o n K a r o l y i , R a m o s - F o r d and G a r d n e r (2003) note the i m p o r t a n c e o f seeing m u l t i p l e intelligences as often separate f r o m e a c h other, and to r e m a i n aware o f the p o s s i b l e " a s y n c h r o n y " o f such intelligences a m o n g gifted individuals. S i l v e r m a n (1998) suggests that definitions o f giftedness such as those p r o p o s e d b y the C o l u m b u s G r o u p (1991), attempt to define giftedness "through the lens o f the gifted s e l f . D e f i n i t i o n s and conceptualisations o f giftedness such as these h i g h l i g h t the " c o m p l e x i t y o f the i n d i v i d u a l ' s thought processes, the intensity o f sensation, e m o t i o n , a n d i m a g i n a t i o n , and the extraordinary awareness that results f r o m this f u s i o n " ( C o l u m b u s G r o u p , 1991 as c i t e d i n S i l v e r m a n , 1998, D e f i n i t i o n s o f Giftedness S e c t i o n , f 4). S c h u l t z and D e l i s l e (2003) suggest that what identifies gifted adolescents is as u n i q u e as the adolescents themselves.  It is suggested that intellectual, p s y c h o m o t o r , e m o t i o n a l ,  sensual, and i m a g i n a t i o n a l o v e r e x c i t a b i l i t i e s as referred to b y P i e c h o w s k i ( 1 9 9 1 , as c i t e d i n S c h u l t z & D e l i s l e 2 0 0 3 ) based o n the w o r k o f D a b r o w s k i (1964, as c i t e d i n S c h u l t z & D e l i s l e 2 0 0 3 ) m a y affect e v e r y r e a l m o f gifted adolescents' experience.  Strategies to support a n d  17  nurture gifted adolescents d u r i n g a c r i t i c a l d e v e l o p m e n t a l phase are suggested w h i l e k e e p i n g i n m i n d u n i q u e d e v e l o p m e n t a l needs. S e v e r a l theorists and researchers i n the f i e l d o f giftedness refer to h e i g h t e n e d sensitivities, awareness, and " o v e r e x c i t a b i l i t i e s " a m o n g gifted i n d i v i d u a l s (e.g. A c k e r m a n & & P a u l u s , 1997; B o u c h e t & F a l k , 2 0 0 1 ; J a c k s o n , 1995; J a c k s o n & Peterson, 2 0 0 3 ; S c h u l t z & D e l i s l e , 2 0 0 3 ; S i l v e r m a n , 1994, 1998; P i e c h o w s k i , 1997, 2 0 0 3 ) . S u c h theorists refer to the i m p o r t a n c e o f c o n s i d e r i n g s u c h o v e r e x c i t a b i l i t i e s i n the conceptualisation and u n d e r s t a n d i n g o f giftedness. A c k e r m a n and P a u l u s (1997) refer also to difficulties i n the m e a s u r e m e n t and d e f i n i t i o n o f giftedness, and propose measurement o f p s y c h i c o v e r e x c i t a b i l i t i e s i d e n t i f i e d b y D a b r o w s k i (1964, as c i t e d i n A c k e r m a n & P a u l u s 1997) i n the i d e n t i f i c a t i o n o f gifted adolescents. F i v e o v e r e x c i t a b i l i t i e s , p s y c h o m o t o r , sensual, i m a g i n a t i o n a l , i n t e l l e c t u a l a n d e m o t i o n a l , are c o n s i d e r e d and defined as d e v e l o p m e n t a l potentials. G r a n t and P i e c h o w s k i (1999) suggest that m a n y conceptualisations o f giftedness focus less o n the inner e x p e r i e n c e o f gifted i n d i v i d u a l s than those that consider o v e r e x c i t a b i l i t i e s . P i e c h o w s k i (1997) describes and elaborates o n the f i v e "forms and expressions o f o v e r e x c i t a b i l i t i e s " . A b r i e f o u t l i n e o f these i n c l u d e s : 1) P s y c h o m o t o r o v e r e x c i t a b i l i t y as i n v o l v i n g a "surplus o f e n e r g y " or " p s y c h o m o t o r e x p r e s s i o n o f e m o t i o n a l tension", 2) Sensual o v e r e x c i t a b i l i t y as i n v o l v i n g " e n h a n c e d sensory and aesthetic pleasure" and "sensual e x p r e s s i o n o f e m o t i o n a l t e n s i o n " , 3) Intellectual o v e r e x c i t a b i l i t y as i n v o l v i n g " i n t e n s i f i e d a c t i v i t y o f the m i n d " , "penchant for p r o b i n g questions and p r o b l e m s o l v i n g " and "reflective thought", 4) I m a g i n a t i o n a l o v e r e x c i t a b i l i t y as i n v o l v i n g "free p l a y o f i m a g i n a t i o n " , "capacity for l i v i n g i n the w o r l d o f fantasy", "spontaneous i m a g e r y as an e x p r e s s i o n o f e m o t i o n a l t e n s i o n " a n d " l o w tolerance for b o r e d o m " ,  5) E m o t i o n a l o v e r e x c i t a b i l i t y as i n v o l v i n g "feelings and e m o t i o n s  18  i n t e n s i f i e d " , " s t r o n g s o m a t i c expressions", "strong affective e x p r e s s i o n s " , " c a p a c i t y for strong attachments, deep relationships, well-differentiated feelings t o w a r d the s e l f  (pp.  3 6 8 - 3 6 7 ) . T h e s e o v e r e x c i t a b i l i t i e s are often characterized as heightened e x p e r i e n c i n g , o r w a y s i n b e i n g i n the w o r l d e x p e r i e n c e d b y gifted adolescents. P i e c h o w s k i (2003) focuses attention o n e m o t i o n a l giftedness and o v e r e x c i t a b i l i t i e s a n d also incorporates s p i r i t u a l giftedness i n recent conceptualisations o f giftedness. J a c k s o n a n d Peterson (2003) e m p h a s i z e the need for c l i n i c i a n s a n d educators to be aware o f the r e l a t i o n s h i p between these o v e r e x c i t a b i l i t i e s a n d p s y c h o l o g i c a l distress o r maladjustment a m o n g gifted adolescents, and outline c o m m o n traits possessed b y h i g h l y gifted adolescents. I n t r o v e r s i o n c h a r a c t e r i z e d b y a " r i c h inner l i f e " , h e i g h t e n e d s e n s i t i v i t y , and o v e r e x c i t a b i l i t i e s a m o n g gifted c h i l d r e n are seen as p l a c i n g these c h i l d r e n "at odds w i t h their v a r i o u s c o n t e x t s " a n d they m a y experience b e i n g "out o f s y n c " o r i n a "state o f i n n e r d i s e q u i l i b r i u m " (p. 177).  Development of Gifted Girls and Young Women S i l v e r m a n (1994) describes adolescence as a "precarious p e r i o d for gifted g i r l s " (p. 141). S i l v e r m a n notes that societal messages force a c h o i c e between giftedness a n d f e m i n i n i t y for gifted adolescent girls. A d o l e s c e n c e is seen as a v u l n e r a b l e t i m e f o r gifted adolescent g i r l s , w h e n societal pressures related to thinness a n d attractiveness m a y render these y o u n g w o m e n v u l n e r a b l e to d i s o r d e r e d eating. K e r r (2000), a noted researcher i n the area o f gifted female d e v e l o p m e n t , remarks on the changes i n w o m e n a n d g i r l s ' roles a n d s o c i a l i z a t i o n i n past several decades. A l t h o u g h they n o w engage i n m o r e t r a d i t i o n a l l y m a l e roles, K e r r (2000) suggest that y o u n g w o m e n are "oppressed m o r e than ever b y s o c i e t a l  images o f the 'perfect' w o m a n " (p. 649). K e r r also c o m m e n t s o n the d i l e m m a f a c e d b y adolescent females to actualize their gifted potential, yet to c o n t i n u e to meet the requirement o f t r a d i t i o n a l female roles, and the needs o f others, both at h o m e and i n the larger c o m m u n i t y . K e r r (2000) challenges the notions that gifted adolescent females are s o m e h o w protected f r o m s o c i a l pressures or maladjustment due to their i n t e l l i g e n c e or a b i l i t y and c a l l s for means o f i d e n t i f i c a t i o n and strategies to support these y o u n g w o m e n as they t r a n s i t i o n to a d u l t h o o d . K e r r a n d N i c p o n (2003) suggest that gifted y o u n g w o m e n are adept at adjusting to " s o c i e t y ' s e x p e c t a t i o n " o f t h e m (p. 4 9 0 ) . Sands a n d H o w a r d - H a m i l t o n (1995) address depression a m o n g gifted f e m a l e adolescents, and speak to the i n e v i t a b l e pressures and m i x e d messages e x p e r i e n c e d throughout this d e v e l o p m e n t a l stage. It is suggested that life for these adolescents c a n be " e x t r e m e l y c o m p l e x and frustrating" w h i l e they identify and attempt to c o n f o r m to s o c i e t a l expectations related to gender role and the " d i v e r s e p u l l s o n their p s y c h e " (% 2; f 4 ) . A s w i t h m u c h o f the literature related to gifted female adolescent d e v e l o p m e n t , it is v i e w e d as a t i m e w h e n these y o u n g w o m e n , w h o m a y have p r e v i o u s l y been e n c o u r a g e d to f u l f i l l their gifted potential are then c o n c u r r e n t l y pressured b y the e m e r g i n g demands to meet the requisite societal gender roles and i d e a l images o f w o m e n (Sands & H o w a r d - H a m i l t o n , 1995).  Eating Disorders Among  Adolescents  G i f t e d adolescent females m a y have u n i q u e experiences o f societal pressures, yet those pressures e x i s t and m a y affect a l l adolescent females. T h e e x p e r i e n c e o f d i s o r d e r e d eating as it relates to societal and gender r o l e expectations and pressures w i l l be b r i e f l y  20  e x p l o r e d , as w i l l p e r s o n a l i t y variables and r i s k factors a m o n g adolescents that m a y be related to the d e v e l o p m e n t o f eating disorders. Slater, G u t h r i e s and B o y d (2001) r e v i e w literature p e r t a i n i n g to adolescent m e n t a l health issues such as depression, eating disorders, substance abuse, v i o l e n c e and abuse t h r o u g h a f e m i n i s t perspective. It is suggested " n o t i o n s and roles o f f e m i n i n i t y , that are b o t h e x p e c t e d and d e v a l u e d " are taught at a y o u n g age to girls (p. 4 4 3 ) . It is the pressure o f these roles that m a y l e a d to p s y c h o l o g i c a l health r i s k s a n d a disproportionate n u m b e r o f adolescent • females d e v e l o p i n g eating disorders. In a r e v i e w o f current literature p e r t a i n i n g to eating disorders a m o n g adolescents, Pratt, P h i l l i p s , G r e y d a n u s and P a t e l (2003) refer to the scarcity o f e m p i r i c a l research i n the f i e l d o f eating disorders s p e c i f i c to adolescent p o p u l a t i o n s , despite m o r e attention to this t o p i c i n recent years. T h e authors suggest that research i n the eating d i s o r d e r f i e l d is fraught w i t h d e s i g n f l a w s , and p a r t i c u l a r l y neglects p o p u l a t i o n s o f adolescents as the p r i m a r y or e x c l u s i v e focus o f research studies. A s the onset o f eating disorders is t y p i c a l l y d u r i n g adolescence, and as a s i g n i f i c a n t p r o p o r t i o n o f the w o r l d ' s p o p u l a t i o n f a l l into this category, this leaves a gap i n the current state o f k n o w l e d g e (Pratt, P h i l l i p s , G r e y d a n u s & P a t e l , 2 0 0 3 ) . T h e r i s i n g i n c i d e n c e o f eating disorders a m o n g adolescents i n v a r i o u s cultures is noted. T h e study o f eating disorders s p e c i f i c to adolescents through a d e v e l o p m e n t a l perspective is warranted, b o t h due to the fact that adolescents m a y have been e n g a g i n g i n eating d i s o r d e r e d b e h a v i o u r for a shorter p e r i o d o f t i m e , and hence m a y r e s p o n d m o r e r e a d i l y and p o s i t i v e l y to treatment, and also due to the fact that eating disorders m a y o c c u r at c r i t i c a l stages o f m a t u r a t i o n or d e v e l o p m e n t (Steiner & L a s k , 1998, as c i t e d i n Pratt, P h i l l i p s , G r e y d a n u s & Patel, 2003).  21  Pratt, P h i l l i p s , G r e y d a n u s and P a t e l (2003) identify several p r e d i s p o s i n g o r r i s k factors ( b i o l o g i c a l and genetic, p h y s i o l o g i c a l , and health b e h a v i o u r factors) that m a y relate to the d e v e l o p m e n t o f eating disorders a m o n g adolescents. T h e y c o n c l u d e that n o d e f i n i t i v e or clear e v i d e n c e exists that sheds l i g h t o n w h i c h adolescents m a y or m a y not u l t i m a t e l y d e v e l o p an eating disorder. R e v i e w o f the current literature suggests that c o m m o n c o m o r b i d disorders a m o n g adolescents w i t h eating disorders are "depression, anxiety, substance abuse, o b s e s s i v e - c o m p u l s i v e disorders, personality disorders, and post-traumatic stress d i s o r d e r s " (p. 302). Pratt, P h i l l i p s , G r e y d a n u s and P a t e l suggest that studies e x p l o r i n g c o m o r b i d disorders m a y be s k e w e d due to participant samples b e i n g recruited f r o m p s y c h i a t r i c or s p e c i a l i z e d eating disorders treatment centers, w h e r e p s y c h o p a t h o l o g y m a y be m o r e serious or m u l t i p l e p a t h o l o g i e s m a y exist. It is c o n c l u d e d that regardless o f the true state o f c o m o r b i d c o n d i t i o n s a m o n g adolescents w h o experience eating disorders, it is d i f f i c u l t to determine w h i c h d i s o r d e r was p r e - e x i s t i n g . Pratt, P h i l l i p s , G r e y d a n u s and P a t e l r e c o m m e n d m a n y d i r e c t i o n s for future research s p e c i f i c to the prevalence, r i s k , e t i o l o g y a n d treatment o f eating disorders a m o n g adolescents. A s i g n i f i c a n t amount o f literature addresses p o s s i b l e p e r s o n a l i t y a n d r i s k factors that m a y contribute to the d e v e l o p m e n t o f eating disorders a m o n g adolescents. M u s s e l l , B i n f o r d and F u l k e r s o n (2000) e x p l o r e p e r s o n a l i t y and r i s k factors that m a y contribute to eating disorders f r o m a p r e v e n t i o n stance. B a s e d o n r e v i e w o f c u r r e n t l y a v a i l a b l e research, they suggest that p e r s o n a l i t y r i s k factors for eating disorders i n c l u d e negative s e l f - e v a l u a t i o n , l o w self-esteem, a n d p e r c e i v e d ineffectiveness, u s i n g eating disorders to c o p e w i t h feelings o f i n a d e q u a c y , a n d negative e m o t i o n a l i t y , w h i c h poses a greater r i s k w h e n c o m b i n e d w i t h other r i s k factors. A t h l e t i c , d e v e l o p m e n t a l , traumatic, f a m i l i a l , and b i o l o g i c a l factors, as w e l l as  22  s o c i o c u l t u r a l factors s u c h as societal p r e o c c u p a t i o n w i t h w e i g h t , thinness a n d d i e t i n g as they relate to culture and gender m a y also be p r e d o m i n a n t r i s k factors. G u a l , et a l . (2002) e x p l o r e d self-esteem and p e r s o n a l i t y v a r i a b l e s as they relate to r i s k factors f o r eating disorders a m o n g a large sample o f adolescent w o m e n (n= 2 8 6 2 females f r o m a n a t i o n a l s a m p l e i n S p a i n ) , as part o f a representative baseline s a m p l e to be e x p l o r e d t h r o u g h a later p r o s p e c t i v e study. L o w self-esteem and h i g h l e v e l s o f n e u r o t i c i s m d e s c r i b e d as "related to p e r f e c t i o n i s m , r i g i d i t y , meticulousness, [and] c o n c e r n o v e r m i s t a k e s " were f o u n d (p. 2 7 0 ) . M c V e y , P e p l a r , D a v i s , Flett, and A b d o l e l l (2002) used a c r o s s - s e c t i o n a l d e s i g n to e x p l o r e b o t h r i s k and protective factors for d i s o r d e r e d eating a m o n g adolescents, b a s e d o n a r e v i e w o f pertinent research. F a m i l i a l support, p e r f e c t i o n i s m (prescribed b y s e l f a n d b y others), negative self-perceptions o f appearance and s o c i a l acceptance w e r e their f o c i . F i n d i n g s i n c l u d e : " h i g h self-oriented p e r f e c t i o n i s m , l o w competence ratings for p h y s i c a l appearance, h i g h self ratings o f i m p o r t a n c e o f s o c i a l acceptance b y peers, and l o w paternal support" as related to d i s o r d e r e d eating (p. 88).  Specific Literature-Eating Disorders Among Gifted Females and Adolescents A t h o r o u g h r e v i e w o f current literature i d e n t i f i e d that d i s o r d e r e d eating a m o n g gifted i n d i v i d u a l s is rarely s p e c i f i c a l l y addressed. E a t i n g disorders are c o m m e n t e d o n a n d a l l u d e d to i n several articles related to gifted adolescent d e v e l o p m e n t and p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s (Nugent, 2 0 0 0 ; Peterson, 1998; S i l v e r m a n , 1994; 1999). T h e l a c k o f research articles s p e c i f i c a l l y p e r t a i n i n g to gifted females and disordered eating, either q u a l i t a t i v e or quantitative, represents a gap i n the literature. F e w articles other than G a r n e r (1991) a n d  23  G a t t o - W a l d e n (1999) address this area s p e c i f i c a l l y , and both articles are b a s e d o n l y o n anecdotal e v i d e n c e , c l i n i c a l o p i n i o n and reference to other related literature sources. A l t h o u g h the expertise a n d insight shared b y these authors is v a l u a b l e , to m y k n o w l e d g e a research-based a p p r o a c h to this area has not been p u b l i s h e d . S i l v e r m a n (1994) e x a m i n e s the p r e o c c u p a t i o n w i t h w e i g h t a n d appearance a m o n g gifted adolescents g i r l s . T h e i m p a c t o f the societal v a l u e o f attractiveness rather than a c h i e v e m e n t or i n t e l l i g e n c e a m o n g gifted adolescent girls is d i s c u s s e d . T h e d e v e l o p m e n t o f eating disorders, w e i g h t and appearance preoccupations a m o n g gifted girls and a n e e d for s o c i a l acceptance are e m p h a s i s e d . K e r r (2000) a n d K e r r and N i c p o n (2003) refer to e a t i n g disorders and p r e o c c u p a t i o n w i t h p h y s i c a l appearance as "at r i s k " b e h a v i o u r s a m o n g g i f t e d adolescents, as they are k e e n l y aware and perceptive o f societal expectations and pressures on them. S i l v e r m a n (1999) addresses p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s , a n d its r e l a t i o n s h i p to eating disorders is a l l u d e d to i n this article. S i l v e r m a n e m p h a s i z e s that a m o n g gifted i n d i v i d u a l s " p e r f e c t i o n i s m needs to be appreciated as a t w o - e d g e d s w o r d that has p o t e n t i a l f o r p r o p e l l i n g an i n d i v i d u a l t o w a r d u n p a r a l l e l e d greatness or p l u m m e t i n g one into despair" (p. 2 1 6 ) . Peterson (1998) notes m a n y o f the particular s o c i a l and p s y c h o l o g i c a l v u l n e r a b i l i t i e s o f gifted adolescents. B a s e d o n p r o f e s s i o n a l e x p e r i e n c e and anecdotal e v i d e n c e , it is suggested that a m o n g s e c o n d a r y - l e v e l gifted students eating disorders pose a "serious c o n c e r n " (p. 197). K e r r and N i c p o n (2003) suggest that gifted y o u n g w o m e n are h i g h l y sensitive to understanding " s o c i e t y ' s expectations" o f t h e m a n d m a y be susceptible to the pressure o f and m e a n i n g o f thinness (p. 4 9 0 ) . E a t i n g disorders a m o n g gifted adolescents  24  are seen as p o s s i b l y h a v i n g a distinct m e a n i n g a m o n g this p o p u l a t i o n that m a y differ f r o m non-gifted peers, or relate to achievement needs. N i e h a r t (2000) addresses the t o p i c o f eating disorders a m o n g gifted i n d i v i d u a l s i n a r e v i e w o f the e m p i r i c a l literature o f the i m p a c t o f giftedness o n p s y c h o l o g i c a l w e l l - b e i n g . T h i s article e x a m i n e s several research studies that have investigated the i n t e l l e c t u a l f u n c t i o n i n g o f i n d i v i d u a l s e x p e r i e n c i n g eating disorders. B y d e f i n i n g gifted o n l y b y i n t e l l e c t u a l f u n c t i o n i n g o r I Q , N i e h a r t (1999) has not i n c o r p o r a t e d other elements o f d i v e r s e d e f i n i t i o n s o f giftedness. T h i s m a y be expected g i v e n that o n l y e m p i r i c a l research is r e v i e w e d , and I Q is the m o s t t y p i c a l means through w h i c h giftedness has been o p e r a t i o n a l i z e d i n e m p i r i c a l research. D e s p i t e suggesting a r e v i e w o f e m p i r i c a l research, N i e h a r t (1999) refers i n detail to G a r n e r ' s (1991) article addressing gifted adolescents a n d eating disorders, w h i c h is not based o n specific research f i n d i n g s . N i e h a r t (1999) presents results f r o m a s m a l l selection o f articles addressing the i n t e l l e c t u a l f u n c t i o n i n g o f i n d i v i d u a l s e x p e r i e n c i n g eating disorders. T h e e x i s t i n g c o n t r o v e r s y between whether eating d i s o r d e r samples e x h i b i t h i g h i n t e l l e c t u a l f u n c t i o n i n g or i n t e l l e c t u a l f u n c t i o n i n g that is w i t h i n a n o r m a l statistical d i s t r i b u t i o n , is addressed. A r t i c l e s such as D a l l y and G o m e z (1979) and R o w l a n d (1970) are presented to support the v i e w that i n t e l l e c t u a l f u n c t i o n i n g a m o n g i n d i v i d u a l s w h o experience eating disorders m a y be above average. D a l l y and G o m e z (1979) f o u n d that I Q scores o f 130 or greater were f o u n d i n o v e r 9 0 % o f an adolescent eating d i s o r d e r s a m p l e , and R o w l a n d (1970 as c i t e d i n N i e h a r t , 1999) f o u n d I Q scores o f 120 o r above a m o n g a s a m p l e o f eating disorder patients. In contrast to these f i n d i n g s , an article b y T o u y z , B e u m o n t and Johnstone (1986 as c i t e d i n N i e h a r t , 1999) is presented w h i c h f o u n d that the I Q scores o f eating disorder patients d i d not v a r y f r o m the n o r m a l d i s t r i b u t i o n o f I Q  25 scores w i t h i n the general p o p u l a t i o n . L i t t l e detail r e g a r d i n g the s a m p l e or m e t h o d s u s e d i n the selected studies presented is g i v e n and recently p u b l i s h e d articles w i t h this s p e c i f i c focus are neglected. G a t t o - W a l d e n (1999) reflects o n her c l i n i c a l experience c o u n s e l l i n g gifted w o m e n a n d f e m a l e adolescents e x p e r i e n c i n g disordered eating. S h e asserts that the percentage o f gifted f e m a l e adolescents and adults e x p e r i e n c i n g disordered eating i n her c o u n s e l l i n g practice has increased d r a m a t i c a l l y i n recent years. T h i s article is one o f the f e w that s p e c i f i c a l l y addresses disordered eating issues and c o u n s e l l i n g a m o n g gifted adolescents and w o m e n . L i t t l e research e v i d e n c e is presented i n this article and m u c h o f the i n f o r m a t i o n g i v e n i n based o n l y o n c l i n i c a l observations. S e v e r a l o f the descriptions o f gifted w o m e n ' s e x p e r i e n c e o f d i s o r d e r e d eating are not differentiated i n any w a y f r o m the e x p e r i e n c e o f n o n gifted i n d i v i d u a l s noted i n the literature. G a t t o - W a l d e n (1999) suggests that a m o n g the gifted clients s t r u g g l i n g w i t h d i s o r d e r e d eating, several characteristics are c o m m o n . T h e s e characteristics i n c l u d e : " P e r s o n a l identity that has d i s o w n e d b e i n g gifted, d e b i l i t a t i n g p e r f e c t i o n i s m , e x c e s s i v e need to please others, experience o f i s o l a t i o n and l o n e l i n e s s , stressful transition d u r i n g the onset o f the disorder and f a m i l y d y n a m i c s w h i c h m a y i n c l u d e : o v e r p r o t e c t i o n , enmeshment, perfectionistic f a m i l y standards and abuse or a d d i c t i v e b e h a v i o u r " (p. 119). G a r n e r (1991), an i n f l u e n t i a l researcher and author i n the f i e l d o f d i s o r d e r e d eating, addresses the "nature and scope o f the p r o b l e m " o f disordered eating a m o n g gifted adolescents. H e asserts that gifted adolescents " m a y be m o r e v u l n e r a b l e to the d e v e l o p m e n t o f b o t h a n o r e x i a n e r v o s a and b u l i m i a n e r v o s a because [they] possess m a n y traits that have  26  been i d e n t i f i e d as r i s k factors for eating d i s o r d e r s " (p. '61). G a r n e r suggests that " p o t e n t i a l p r e d i s p o s i n g factors...seem p a r t i c u l a r l y relevant to those w h o m a y be i d e n t i f i e d as gifted, (p. 52) G a r n e r describes p o s s i b l e factors i n f l u e n c i n g the d e v e l o p m e n t o f d i s o r d e r e d eating a m o n g gifted adolescents as c o m p e t i t i v e settings, w e i g h t loss as "another area f o r d i s p l a y i n g p e r s o n a l c o m p e t e n c e " , l o w self esteem, p e r f e c t i o n i s m and e d u c a t i o n a l p r o g r a m s w h i c h focus o n p e r f o r m a n c e , p e r s o n a l mastery, and v o c a t i o n , p o s s i b l y n e g l e c t i n g other i m p o r t a n t areas o f female p s y c h o l o g i c a l d e v e l o p m e n t (p. 53). L e r o u x and C u f f a r o (2001) e x p l o r e the r e l a t i o n s h i p o f h i g h a c a d e m i c a b i l i t y to eating disorders a m o n g adolescent females. A l t h o u g h the focus o f this article s h o w e d p r o m i s e for a strong c o n t r i b u t i o n to relevant research p e r t a i n i n g to this study, m a n y o f the references u s e d to d r a w out the relevant factors are not research-based or a c a d e m i c i n nature. S e v e r a l o f the a c a d e m i c sources referred to appear to have been p u b l i s h e d o v e r 10 years ago, w h i c h m a y result i n outdated i n f o r m a t i o n . D e s p i t e the weakness o f the sources c i t e d , several relevant factors that a p p l y to b o t h i n d i v i d u a l s w h o experience eating disorders and those w h o are h i g h i n a c a d e m i c a b i l i t y are i d e n t i f i e d . Factors that m a y intersect b o t h eating d i s o r d e r e x p e r i e n c e and h i g h a b i l i t y as suggested b y L e r o u x and C u f f a r o (2001) i n c l u d e : h y p e r s e n s i t i v i t y ; persistence; p e r f e c t i o n i s m , h i g h achievement, orientation/expectations; an i n t r o s p e c t i v e a n d i n t u i t i v e nature; intensity, e x c i t a b i l i t y , i m p u l s i v e n e s s ; c o m p e t i t i v e n e s s ; h i g h I Q ; a c a d e m i c e x c e l l e n c e ; c o n s c i e n t i o u s n e s s ; p r e c o c i o u s b e h a v i o u r s and h y p e r m a t u r i t y (p. 113). T h e article c o n c l u d e s w i t h r e c o m m e n d a t i o n s for h o w to address p r e v e n t i o n strategies for eating disorders, a l t h o u g h n o r e c o m m e n d a t i o n s appear to take into account any o f the factors that were o u t l i n e d as a p p l y i n g to b o t h eating disorders and h i g h a b i l i t y female adolescents.  27  Intellectual and Cognitive Ability Related to Eating Disorders C l i n i c a l i m p r e s s i o n s o f adolescents w h o e x p e r i e n c e d i s o r d e r e d eating often refer to the h i g h a c a d e m i c achievement and i n t e l l e c t u a l a b i l i t i e s o f these y o u n g w o m e n , yet research i n this area has f a i l e d to support these c l a i m s i n m a n y instances ( B l a n z , D e t z n e r , L a y , R o s e & S c h m i d t , 1997; R a n s e e n & H u m p h r i e s , 1992). B l a n z , D e t z n e r , L a y , R o s e and S c h m i d t (1997) investigated the i n t e l l e c t u a l f u n c t i o n i n g o f a large s a m p l e o f eating disorder patients u s i n g a c o m p a r i s o n g r o u p w h o e x p e r i e n c e d other p s y c h o l o g i c a l disorders. A n o v e r v i e w o f other studies that i n v e s t i g a t e d full-scale I Q measures i n eating disorder patients p u b l i s h e d between 1976 and 1992 w a s presented. T h e heterogeneous f i n d i n g s and m e t h o d o l o g i c a l weaknesses i n p r e v i o u s studies w e r e addressed. In this study the m e a n age o f the eating disorder s a m p l e w a s 15.4 and i n c l u d e d 1 9 0 out-patients and inpatients w i t h a d i a g n o s i s o f B u l i m i a N e r v o s a or A n o r e x i a N e r v o s a b e t w e e n 1976 and 1993. T h e c o m p a r i s o n group shared characteristics o f age, sex, s o c i o e c o n o m i c status, and years o f a d m i s s i o n . N o c o m m u n i t y c o n t r o l g r o u p was c o n s i d e r e d . R e s u l t s o f the study f o u n d that the " I Q o f eating disorder patients was s i g n i f i c a n t l y h i g h e r that the c o m p a r i s o n g r o u p " (p. 129). A p o s i t i v e c o r r e l a t i o n , w h i c h was w e a k but s i g n i f i c a n t , was f o u n d b e t w e e n w e i g h t loss before h o s p i t a l i z a t i o n and i n t e l l i g e n c e . T h e authors suggest that there m a y be a r e l a t i o n s h i p between h i g h i n t e l l i g e n c e , a c h i e v e m e n t m o t i v a t i o n a n d a b i l i t y to s u c c e s s f u l l y lose w e i g h t . It is suggested that further studies are necessary to investigate that r e l a t i o n s h i p ( B l a n z et a l . , 1997). R a n s e e n and H u m p h r i e s (1992) investigated the assumptions p r o p o s e d b y p r e v i o u s research a n d c l i n i c a l e v i d e n c e addressing whether eating d i s o r d e r patients h a v e (1) a b o v e average i n t e l l e c t u a l s k i l l s and (2) strengths i n v e r b a l a b i l i t i e s . I Q scores for the s a m p l e w e r e  28  d e r i v e d f r o m standard i n t e l l i g e n c e tests (age appropriate W I S C - R and W A I S - R ) . T h e m e a n age o f the participants was 21.5 and the s a m p l e i n c l u d e d 100 female patients at an e a t i n g d i s o r d e r inpatient unit. N o c o m p a r i s o n group w a s u t i l i z e d i n this study. A l t h o u g h a range i n intellectual f u n c t i o n i n g a m o n g the sample was f o u n d , general i n t e l l e c t u a l f u n c t i o n i n g w a s f o u n d to " r o u g h l y c o n f o r m to the p o p u l a t i o n at l a r g e " (p. 845). S i m i l a r i t i e s i n I Q scores between participants w h o e x p e r i e n c e d A n o r e x i a N e r v o s a , B u l i m i a N e r v o s a a n d E a t i n g D i s o r d e r s O t h e r w i s e S p e c i f i e d were also f o u n d . G i l l b e r g , G i l l b e r g , R a s t a m and J o h a n n s o n (1996) m a k e reference to D a i l y ' s (1969) study w h i c h reported f i n d i n g s o f I Q scores r a n g i n g f r o m 115-138 o f a selected g r o u p o f A n o r e x i a N e r v o s a patients. T h e l a c k o f current, m e t h o d o l o g i c a l l y s o u n d research w h i c h investigates the n e u r o p s y c h o l o g i c a l aspects o f A n o r e x i a N e r v o s a patients is c r i t i c i z e d . G i l l b e r g , G i l l b e r g , R a s t a m and Johansson (1996) e x a m i n e d a c o m m u n i t y - b a s e d s a m p l e o f participants d i a g n o s e d w i t h A n o r e x i a N e r v o s a w i t h onset i n adolescence a p p r o x i m a t e l y 5 years after i n i t i a l d i a g n o s i s and 6-7 years after onset (n=51). F e w e r than 1 0 % o f the e a t i n g d i s o r d e r s a m p l e were b e l o w average w e i g h t at the t i m e o f testing. A n age, sex and s c h o o l m a t c h e d c o m p a r i s o n g r o u p (n=51, m e a n age 21) was u t i l i z e d and c o m p a r i s o n s o n the W A I S R i n t e l l i g e n c e test were c o n s i d e r e d . F u l l - s c a l e I Q scores were not f o u n d to be h i g h e r i n the A n o r e x i a N e r v o s a g r o u p , d i d not differ s i g n i f i c a n t l y f r o m the c o m p a r i s o n g r o u p a n d w e r e f o u n d to be c l o s e to the n o r m a m o n g the general p o p u l a t i o n . D u r a and B o r n s t e i n (1989) e x a m i n e d the relationship between s c h o o l a c h i e v e m e n t and I Q i n a s a m p l e o f adolescents d i a g n o s e d w i t h A n o r e x i a N e r v o s a ( m e a n age= 14.7, n=20). N o c o m p a r i s o n group was c o n s i d e r e d i n this study. D u r a and B o r n s t e i n h y p o t h e s i z e d that based o n " p e r f e c t i o n i s t i c standards" o f the sample, s c h o o l achievement m a y be greater than  29  w o u l d be e x p e c t e d based o n measures o f i n t e l l i g e n c e . A g e appropriate s t a n d a r d i z e d i n t e l l i g e n c e tests ( W I S C - R / W A I S - R ) and measures o f achievement ( W R A T ) w e r e u s e d to e x p l o r e this hypothesis. F u l l - s c a l e I Q scores o f the s a m p l e ranged f r o m 7 9 - 1 2 9 w i t h a m e a n o f 102.45. R e s u l t s support the i n i t i a l hypothesis as achievement scores w e r e reported to be s i g n i f i c a n t l y h i g h e r than w o u l d be predicted b y I Q scores. G a r n e r (1991) also refers to several e m p i r i c a l studies e x a m i n i n g the i n t e l l e c t u a l f u n c t i o n i n g o f adolescents e x p e r i e n c i n g eating disorders and c o m m e n t s o n the l a c k o f c o n s i s t e n c y a m o n g f i n d i n g s . Studies that have reported deficits i n n e u r o p s y c h o l o g i c a l a n d i n t e l l i g e n c e f u n c t i o n i n g (e.g. F o x , 1981; H o l l e m a n , 1985 as c i t e d i n G a r n e r ) are referred to, as are c o n t r a d i c t o r y f i n d i n g s , w h i c h i n d i c a t e d above average f u n c t i o n i n g . D a l l y a n d G o m e z (1979) reported I Q scores o f 130 or greater a m o n g eating disorder patients w i t h onset between 11 and 14 years o f age. R o w l a n d (1970) reported an average I Q o f 113 i n a s a m p l e o f eating d i s o r d e r patients w i t h one t h i r d o f the s a m p l e o b t a i n i n g I Q scores greater than 120 (as c i t e d i n G a r n e r , 1991). R o w l a n d (1970) and T o u y z , B e u m o n t a n d Johnstone (1986) presents f i n d i n g s s i m i l a r to D u r a and B o r n s t e i n (1989) suggesting that a c a d e m i c a c h i e v e m e n t and p e r f o r m a n c e are h i g h e r than expected based o n I Q measurements (as c i t e d i n G a r n e r , 1991). G a r n e r (1991) refers to the p o s s i b l e ranges i n i n t e l l e c t u a l f u n c t i o n i n g a m o n g i n d i v i d u a l s e x p e r i e n c i n g eating disorders. S o m e y o u n g w o m e n e x p e r i e n c i n g eating disorders m a y be i d e n t i f i e d as gifted based o n s c h o o l achievement, w h i c h m a y or m a y not be the result o f above average i n t e l l e c t u a l f u n c t i o n i n g . O t h e r y o u n g w o m e n m a y be " t r u l y i n t e l l e c t u a l l y g i f t e d " a n d d e v e l o p an eating disorder w h i c h " m a y relate to p a r t i c u l a r r i s k s factors associated w i t h the giftedness or its i d e n t i f i c a t i o n " (p. 52).  30  Empirical Research Review of Giftedness and Psychological  W ell-Being 7  N i e h a r t (1999) r e v i e w s the e m p i r i c a l literature p e r t a i n i n g to p s y c h o l o g i c a l w e l l b e i n g a m o n g gifted i n d i v i d u a l s . N i e h a r t h i g h l i g h t s the prevalent c o n t r o v e r s y that exists i n current a n d h i s t o r i c a l literature related to whether giftedness enhances p s y c h o l o g i c a l r e s i l i e n c y or increases v u l n e r a b i l i t y . N i e h a r t r e v i e w s literature that s p e c i f i c a l l y addresses r i s k for maladjustment a m o n g gifted i n d i v i d u a l s and g l o b a l measures o f adjustment (e.g., c o p i n g , response to e n v i r o n m e n t , p e r s o n a l i t y ) . Giftedness and its relation to self-concept, d e p r e s s i o n , anxiety, s u i c i d e , s o c i a l competence, deviant b e h a v i o u r , a n d p s y c h i a t r i c disorders (eating disorders, m o o d disorders) are also addressed. N i e h a r t (1999) c o n c l u d e s that although this c o n t r o v e r s y continues, " i t is c l e a r that giftedness influences the p s y c h o l o g i c a l f u n c t i o n i n g and w e l l - b e i n g o f an i n d i v i d u a l " (Introduction section, \ 1). T h i s influence m a y have negative or p o s i t i v e i m p l i c a t i o n s f o r the i n d i v i d u a l a n d it is asserted that interacting factors such as the type o f giftedness, the fit b e t w e e n the i n d i v i d u a l a n d their e n v i r o n m e n t s u c h as educational p r o g r a m , and the i n d i v i d u a l ' s p e r s o n a l characteristics, m a y a l l determine u n i q u e characteristics o f p s y c h o l o g i c a l adjustment a m o n g gifted i n d i v i d u a l s .  Self Esteem, Self-Concept, Emotional Resilience and Gifted G a l l a g h e r (2003) refers to the c o n f l i c t i n g v i e w p o i n t s r e g a r d i n g the s o c i a l a n d e m o t i o n a l d e v e l o p m e n t o f gifted i n d i v i d u a l s . T h e s e t w o v i e w s d i v e r g e o n the t o p i c o f whether giftedness protects f r o m , or creates m o r e r i s k for maladjustment.  Gallagher  p r o v i d e s n o c o n c l u s i o n but suggests that giftedness does not render students i m m u n e to  31  maladjustment and indicates that r e v i e w s o f the literature generally suggest that o n average there is little difference i n e m o t i o n a l adjustment between gifted and n o n - g i f t e d p o p u l a t i o n s . A s f o u n d i n m a n y areas o f gifted literature, there remains a c o n t r o v e r s y b e t w e e n w h e t h e r gifted adolescents experience s i m i l a r or l o w e r self esteem and self-concept than n o n - g i f t e d peers. N i e h a r t (1999) p r o v i d e s an o v e r v i e w o f research i n this area and e m p h a s i z e s the i n c o n s i s t e n c y and l a c k o f consensus o n measures o f self-concept or self-esteem a m o n g gifted i n d i v i d u a l s . M o s t a v a i l a b l e research suggests a l o w e r self-esteem and self-concept a m o n g gifted p o p u l a t i o n s although c o n f l i c t i n g results exist (e.g. H o g e and R e n z u l l i , 1993). L e a - W o o d and C l u n i e s - R o s s (1995) refer to these c o n t r o v e r s i a l f i n d i n g s related to self-esteem o f gifted versus non-gifted adolescents. T h e authors suggest that gifted g i r l s m a y be c o n s i d e r e d " d o u b l y d i s a d v a n t a g e d " because they are both gifted and f e m a l e ( I n t r o d u c t i o n S e c t i o n , f 1). A n A u s t r a l i a n s a m p l e o f 158 adolescent girls i n years 7, 8 a n d 9 o f the post p r i m a r y years p a r t i c i p a t e d i n the study (81 gifted and 77 non-gifted). S e l f - e s t e e m was m e a s u r e d u s i n g the C o o p e r s m i t h S e l f - E s t e e m Inventory ( C o o p e r s m i t h , 1987 as c i t e d i n L e a W o o d & C l u n i e s - R o s s , 1995). Quantitative f i n d i n g s o f this study suggest that gifted students i n the s a m p l e h a d b o t h l o w e r total self-esteem and s o c i a l self-esteem scores w h e n c o m p a r e d to the n o n - g i f t e d group. K l i n e and S h o r t (1991) c o n d u c t e d an e m p i r i c a l cross-sectional study to e x a m i n e the s o c i a l and e m o t i o n a l changes o f gifted females throughout the s c h o o l years. i n c l u d e d 89 gifted females (n=58 i n the 9 - 1 2 t h  the l - 4 s t  t h  t h  grade, n=15 i n the 5 - 8 t h  t h  Subjects  grade, a n d n=16 i n  grade). N o n o n - g i f t e d c o m p a r i s o n group was c o n s i d e r e d i n this study. P a r t i c i p a n t s  were a d m i n i s t e r e d a 1 3 8 - i t e m questionnaire regarding s o c i a l and e m o t i o n a l aspects o f  32  d e v e l o p m e n t . F i n d i n g s suggested that self-confidence and self-regard a m o n g gifted adolescents decreased s i g n i f i c a n t l y t h r o u g h their s c h o o l d e v e l o p m e n t , m o r e so than n o n gifted peers, a n d that l e v e l s o f p e r f e c t i o n i s m , hopelessness and d i s c o u r a g e m e n t increase. K l e i n and Z e h m s (1996) investigated the self-concept o f i n t e l l e c t u a l l y gifted g i r l s i n grades 3, 5 a n d 8 u s i n g scores f r o m the P i e r s - H a r r i s S e l f - C o n c e p t S c a l e (Piers, 1984 as c i t e d i n K l e i n & Z e h m s ) . T h e participants i n c l u d e d 104 gifted females and a c o m p a r i s o n g r o u p o f o n l y 3 0 n o n - g i f t e d females. F i n d i n g s s h o w e d that the total self-concept scores o f the gifted girls decreased s i g n i f i c a n t l y between grades 3 and 8 and also b e t w e e n grades 5 a n d 8. T h e total self-concept scores o f the non-gifted c o m p a r i s o n group b e t w e e n grades 3 a n d 8 also d e c l i n e d but n o statistically significant difference was f o u n d b e t w e e n grade 5 and 8 f o r this group. It was also reported that a m o n g the gifted grade 8 sample, a m o r e negative sense o f self i n r e l a t i o n to b e h a v i o u r , status (intellectual and s c h o o l ) and p o p u l a r i t y i n c o m p a r i s o n to the n o n - g i f t e d group w a s f o u n d . A b l a r d (1997) a d m i n i s t e r e d the M u l t i d i m e n s i o n a l S e l f - C o n c e p t S c a l e ( B r a c k e n , 1992) a n d the A d j e c t i v e c h e c k l i s t ( G o u g h & H e i l b r u n , 1983 as c i t e d i n A b l a r d , 1997) to 147 a c a d e m i c a l l y talented e i g h t h grade students. T h e s a m p l e was c h o s e n based o n S A T m a t h a n d v e r b a l scores. M e a n scores for the participants were c o m p a r e d to the means o f a n o r m a t i v e p o p u l a t i o n o f adolescents. R e s u l t s o f this study suggest that the a c a d e m i c a l l y talented participants h a d a h i g h e r a c a d e m i c self-concept and s i m i l a r s o c i a l self-concept scores w h e n c o m p a r e d to the n o r m a t i v e group o f h i g h s c h o o l students. A b l a r d (1997) suggests that the group difference r e g a r d i n g a c a d e m i c self-concept m a y reflect a c a d e m i c a b i l i t y . M o d e r a t e l y h i g h e r self-confidence scores were f o u n d a m o n g the a c a d e m i c a l l y talented students. F e m a l e participants i n the a c a d e m i c a l l y talented group r e c e i v e d h i g h e r  33  scores o n the adjective c h e c k l i s t scales related to achievement, d o m i n a n c e a n d endurance. T h e s e scales related to h i g h a c a d e m i c achievement a m o n g this g r o u p . ; T h e females i n the a c a d e m i c a l l y talented group were also less l i k e l y to seek e m o t i o n a l support, s y m p a t h y f r o m others, a n d to express i n f e r i o r i t y and s o c i a l i m p o t e n c e . H o g e and R e n z u l l i (1993) address the d i f f i c u l t y i n d e f i n i n g b o t h self-concept and giftedness.  C o m p a r i s o n s o f gifted and average c h i l d r e n ' s self-concept were e x p l o r e d t h r o u g h  m e t a - a n a l y t i c a l methods. P o s s i b l e hypotheses related to whether gifted c h i l d r e n m a y h a v e h i g h e r or l o w e r self-concepts were p r o p o s e d . T h e construct o f self-concept was further b r o k e n d o w n to c o n s i d e r different types o f self-concept such as " g l o b a l / c o m p o s i t e , a c a d e m i c , s o c i a l , b e h a v i o r , and p h y s i c a l " (p. 4 5 2 ) .  F i n d i n g s f r o m the study indicate that w h e n  addressed as a s i n g l e construct, it appears that the self-concept o f gifted c h i l d r e n is s l i g h t l y h i g h e r than n o n - g i f t e d c h i l d r e n . H o g e and R e n z u l l i propose that m o r e m e a n i n g f u l results are f o u n d w h e n self-concept is b r o k e n d o w n to e x p l o r e various forms o f self-concept. W h e n this is done, m e t a - a n a l y t i c a l f i n d i n g s suggest that gifted c h i l d r e n have m o r e p o s i t i v e a c a d e m i c and b e h a v i o r a l self-concept and that g l o b a l / c o m p o s i t e self-concept was r e l a t i v e l y s i m i l a r for gifted and non-gifted c h i l d r e n , but n o significant difference was f o u n d for p h y s i c a l a n d s o c i a l self-concept. W h e n the effects o f gender and age were c o n s i d e r e d , n o s i g n i f i c a n t effects were f o u n d . H o g e and R e n z u l l i identify several factors that m a y c o m p r o m i s e these research f i n d i n g s , s u c h as the s m a l l n u m b e r o f studies i n c l u d e d i n the meta-analysis, the v a r i a b l e definitions o f b o t h giftedness and self-concept, and the fact that the results f r o m the v a r i o u s studies were also c o n s i d e r a b l y v a r i a b l e . T h i s study does offer an i m p o r t a n t c o n t r i b u t i o n i n that it e m p h a s i z e s the v a r i o u s d o m a i n s i n w h i c h self-concept m a y v a r y .  34 Perfectionism M a n y research contributions relate a higher i n c i d e n c e o f perfectionistic tendencies a m o n g b o t h gifted i n d i v i d u a l s a n d i n d i v i d u a l s w h o experience eating disorders ( A s h b y & K o t t m a n , 1998; B a k e r , 1996; B a s t i a n i , R a o , W e l t z i n & K a y e , 1995; G r e e n s p a n , 2 0 0 0 ; N u g e n t , 2 0 0 0 ; P a r k e r & M i l l s , 1996; S c h u l e r , 2 0 0 0 ; Shafran & M a n s e l l 2 0 0 1 ; S i l v e r m a n , 1999). L i t e r a t u r e p e r t a i n i n g to p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s a n d i n d i v i d u a l s e x p e r i e n c i n g d i s o r d e r e d eating m a y p r o v i d e an important theoretical l i n k r e l a t i n g d i s o r d e r e d eating a n d giftedness. L o C i e r o a n d A s h b y (2000) c a u t i o n that definitions a n d measurements o f p e r f e c t i o n i s m v a r y s i g n i f i c a n t l y i n the literature.  Perfectionism and Eating Disorders Shafran a n d M a n s e l l (2001) p r o v i d e a literature r e v i e w o f p e r f e c t i o n i s m a n d p s y c h o p a t h o l o g y . T h e concept o f p e r f e c t i o n i s m is r e v i e w e d , c r i t i c i s m s o f e x i s t i n g measures o f p e r f e c t i o n i s m are presented a n d " h i g h personal standards" a n d p e r f e c t i o n i s m , p a r t i c u l a r l y a m o n g i n d i v i d u a l s e x p e r i e n c i n g disordered eating are e m p h a s i z e d based o n the r e v i e w o f current literature. D i f f e r e n t i a t i o n between  " p o s i t i v e " a n d " n e g a t i v e " p e r f e c t i o n i s m are  c o n s i d e r e d , a n d these concepts are related to both healthy a n d unhealthy p e r f e c t i o n i s m , as w e l l as n o r m a l a n d neurotic p e r f e c t i o n i s m . Shafran a n d M a n s e l l (2001) assert that "eating disorders have l o n g been associated w i t h p e r f e c t i o n i s m both f r o m a theoretical perspective a n d f r o m a p h e n o m e n o l o g i c a l o n e " (p. 8 8 9 ) . Shafran a n d M a n s e l l (2001) cite research i n d i c a t i n g p e r f e c t i o n i s m as an i d e n t i f i e d r i s k factor f o r i n d i v i d u a l s w i t h A n o r e x i a N e r v o s a , B u l i m i a N e r v o s a a n d B i n g e E a t i n g disorder ( F a i r b u r n et a l . , 1998; F a i r b u r n , C o o p e r , D o l l & W e l c h , 1999 as c i t e d i n Shafran &  35  M a n s e l l , 2 0 0 1 ) . S l a d e (1982 as c i t e d i n Shafran & M a n s e l l , 2001) suggests that p e r f e c t i o n i s m is a "necessary c o n d i t i o n " for A n o r e x i a N e r v o s a to d e v e l o p . V i t o u s e k a n d M a n k e (1995 as c i t e d i n Shafran & M a n s e l l , 2001) consider p e r f e c t i o n i s m to be part o f the p h e n o m e n o l o g y o f A n o r e x i a . B a s t i n i , R a o , W e l t z i n , and K a y e (1995) and S l a d e a n d D e w e y (1986 as c i t e d i n Shafran and M a n s e l l , 2001) f o u n d that i n d i v i d u a l s w i t h A n o r e x i a , s c o r e d higher o n measures o f p e r f e c t i o n i s m c o m p a r e d to controls. B a s t i a n i , R a o , W e l t z i n , and K a y e (1995) report h i g h scores o n measures o f perfectionism among malnourished, underweight individuals experiencing A n o r e x i a N e r v o s a . T h i s p e r f e c t i o n i s m is characterized as " s e l f - i m p o s e d " and h i g h scores o n p e r f e c t i o n i s m measures are reported to persist after w e i g h t has been restored to appropriate l e v e l s i n these i n d i v i d u a l s . It is suggested that h i g h l e v e l s o f p e r f e c t i o n i s m m a y h a v e i m p l i c a t i o n s for resistance to treatment and relapse a m o n g i n d i v i d u a l s e x p e r i e n c i n g A n o r e x i a Nervosa. A s h b y a n d K o t t m a n (1998) e x p l o r e d the relationship between adaptive and m a l a d a p t i v e d i m e n s i o n s o f p e r f e c t i o n i s m a m o n g i n d i v i d u a l s e x p e r i e n c i n g eating disorders. M a l a d a p t i v e p e r f e c t i o n i s m is described b y factors such as " o v e r c o n c e r n s o v e r m i s t a k e s , a n x i e t y about performance, and p r o c r a s t i n a t i o n " ( D i s c u s s i o n S e c t i o n , fl).  Adaptive  p e r f e c t i o n i s m is characterized b y factors such as " h i g h personal standards and need for order a n d o r g a n i z a t i o n " ( D i s c u s s i o n S e c t i o n , fl).  T h e i r findings suggest that i n d i v i d u a l s  r e c e i v i n g treatment for eating disorders scored s i g n i f i c a n t l y higher o n m a l a d a p t i v e p e r f e c t i o n i s m , but not o n measures o f adaptive p e r f e c t i o n i s m . M a l a d a p t i v e p e r f e c t i o n i s m is also reported to correlate w i t h "elevated l e v e l s o f b o d y dissatisfaction, feelings o f  36  ineffectiveness, d i f f i c u l t y r e s p o n d i n g to e m o t i o n s and p e r f e c t i o n i s m " o n subscales o f the E a t i n g D i s o r d e r Inventory ( A s h b y & K o t t m a n , 1998, D i s c u s s i o n S e c t i o n , f 2).  Perfectionism Among Gifted C o n t r o v e r s y s u r r o u n d i n g p e r f e c t i o n i s m and its manifestations a m o n g gifted i n d i v i d u a l s persists i n current literature. P e r f e c t i o n i s m has been associated as a characteristic o f gifted i n d i v i d u a l s , although little e m p i r i c a l literature supports h i g h e r i n c i d e n c e or l e v e l s o f p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s exists (Parker & M i l l s , 1996). S i l v e r m a n ( 1 9 9 9 ) , N u g e n t ( 2 0 0 0 ) , a n d S c h u l e r (2000) a l l address the p r e d o m i n a n c e o f p e r f e c t i o n i s t i c tendencies and negative manifestations o f p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s . S i l v e r m a n (1999) suggests that p e r f e c t i o n i s m is the "least appreciated facet o f giftedness", cites h o w p e r f e c t i o n i s m is an " i n e v i t a b l e " aspect o f giftedness and "needs to be appreciated as a t w o e d g e d s w o r d that has potential for p r o p e l l i n g an i n d i v i d u a l t o w a r d u n p a r a l l e l e d greatness or p l u m m e t i n g one into despair" (p. 216). In reference to the general p o p u l a t i o n , and s p e c i f i c a l l y gifted i n d i v i d u a l s , G r e e n s p a n (2000) characterizes " H e a l t h y P e r f e c t i o n i s m " as an " o x y m o r o n " . G r e e n s p a n (2000) r e v i e w s the literature o f " h e a l t h y " p e r f e c t i o n i s m and suggests that various authors have referred to a c o n t i n u u m o f p e r f e c t i o n i s m w i t h o u t an adequate e m p i r i c a l or theoretical basis. S i l v e r m a n (1999) refers to several authors w h o have noted the l i n k b e t w e e n p e r f e c t i o n i s m and giftedness and suggests that there exist both p o s i t i v e and negative m o t i v a t i o n s and consequences o f p e r f e c t i o n i s m . A n e c d o t a l l y , S i l v e r m a n suggests, " P e r f e c t i o n i s m is an i n e v i t a b l e part o f the experience o f b e i n g g i f t e d " (p. 2 1 6 ) . S i l v e r m a n e m p h a s i z e s a need to v i e w p e r f e c t i o n i s m as not necessarily m a l a d a p t i v e or as a characteristic  37  that needs to be " c u r e d " , although the v i e w that p e r f e c t i o n i s m is a " t w o - e d g e d s w o r d " is m a i n t a i n e d (p. 2 1 6 ) . P e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s is seen as r e l a t i n g to a s y n c h r o n o u s or u n e v e n d e v e l o p m e n t , setting h i g h e r standards than peers, greater a b i l i t y to p r e d i c t the consequences o f b e h a v i o u r , l a c k o f c h a l l e n g e i n s c h o o l e n v i r o n m e n t s , and a d r i v i n g force for h i g h e r l e v e l s o f d e v e l o p m e n t ( S i l v e r m a n , 1999). N u g e n t (2000) suggests that gifted i n d i v i d u a l s are m o r e susceptible to p e r f e c t i o n i s t i c tendencies than the general p o p u l a t i o n . N e g a t i v e manifestations o f p e r f e c t i o n i s m s u c h as eating disorders, depression, underachievement, and substance abuse are noted.  Gifted  students' "heightened sensitivities, awareness and a b i l i t i e s " are addressed as i m p o r t a n t c o n s i d e r a t i o n s i n c o u n s e l l i n g gifted students (Introduction section, 11).  Various  interventions to encourage gifted i n d i v i d u a l s to "break the c y c l e o f d i s a b l i n g p e r f e c t i o n i s m " are suggested ( A b s t r a c t section , % 1). L i t t l e e v i d e n c e is p r o v i d e d , h o w e v e r , to support the negative manifestations o f p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s , or to suggest interventions. S c h u l e r (2000) e x a m i n e d the relationship between p e r f e c t i o n i s m and giftedness a m o n g adolescents u s i n g both quantitative and qualitative data. Participants i n this study ( n = l 12) w e r e students i n grades 7 and 8 i d e n t i f i e d as gifted adolescents. A n o p e r a t i o n a l d e f i n i t i o n o f " g i f t e d adolescent" is not clear and n o c o n t r o l group was c o n s i d e r e d . T h e G o a l and W o r k H a b i t s S c a l e (Schuler, 1994) and a m o d i f i e d v e r s i o n o f the M u l t i d i m e n s i o n a l P e r f e c t i o n i s m S c a l e (Frost, M a r t e n , L a h a r t & R o s e n b l a t e , 1990 as c i t e d i n S c h u l e r , 2 0 0 0 ) were a d m i n i s t e r e d to identify "perfectionistic adolescents".  S c h u l e r (2000) asserts that  p e r f e c t i o n i s m exists o n a c o n t i n u u m o f n o r m a l to neurotic and presents f i n d i n g s that characterize 12.5 % o f the s a m p l e as non-perfectionistic, 5 8 . 0 % as n o r m a l perfectionists, and  38  2 9 . 5 % as neurotic perfectionists. Further qualitative data were obtained f r o m 2 0 participants c h o s e n f r o m the n o r m a l and neurotic perfectionist categories. It is suggested that the " n o r m a l perfectionists" i n the s a m p l e " d i s p l a y self acceptance o f m i s t a k e s , possess an intense need for order and h a d p o s i t i v e role m o d e l s for d o i n g o n e ' s p e r s o n a l best" ( D i s c u s s i o n and I m p l i c a t i o n s section, f 2). T h e "neurotic perfectionists" are c h a r a c t e r i z e d as h a v i n g a "constant need for a p p r o v a l , e x t r e m e l y h i g h standards and were i n a s e e m i n g l y constant state o f a n x i e t y . . . appear to l i v e i n an e m o t i o n a l e n v i r o n m e n t o f c o n d i t i o n a l a p p r o v a l , . . . l a c k effective c o p i n g strategies and had few p o s i t i v e role m o d e l s on h o w to deal w i t h f a i l u r e " ( D i s c u s s i o n a n d I m p l i c a t i o n s section, f 2). . L o C i e r o and A s h b y (2000) investigated the l e v e l s o f adaptive and m a l a d a p t i v e p e r f e c t i o n i s m i n 83 gifted students, grade 6-8, c o m p a r e d to 112 peers i n a general cohort. A d a p t i v e p e r f e c t i o n i s m is described b y factors s u c h as h o l d i n g h i g h p e r s o n a l standards a n d m a l a d a p t i v e p e r f e c t i o n i s m is described b y factors such as increased distress b y d i s c r e p a n c y between h i g h personal standards and performance. Quantitative f i n d i n g s based o n the A l m o s t Perfect S c a l e R e v i s e d ( S l a n e y , et a l , 1996 as c i t e d i n L o C i e r o & A s h b y , 2 0 0 0 ) , suggest that gifted students are m o r e perfectionistic than the c o m p a r i s o n g r o u p but that the gifted students do not score h i g h e r o n measures o f m a l a d a p t i v e p e r f e c t i o n i s m . B a k e r (1996) investigated the e v e r y d a y stressors o f a c a d e m i c a l l y gifted adolescents, b o t h " g i f t e d " and " e x c e p t i o n a l l y gifted" students, i n c o m p a r i s o n to a c a d e m i c a l l y average students. A total o f 146 subjects i n grades 9 to 11 (n=56 average a c a d e m i c a l l y average students, n= 58 gifted students and n=32 e x c e p t i o n a l l y gifted students) p a r t i c i p a t e d i n measures o f hassles, stressors and p s y c h o s o c i a l stressors. T h e areas m e a s u r e d b y the p s y c h o s o c i a l stressor subscale were based o n a literature relevant to giftedness a n d m e a s u r e d  39  stress related to f e e l i n g different, b o r e d o m , s e n s i t i v i t y , p e r f e c t i o n i s m and v o c a t i o n . B a k e r (1996) f o u n d f e w differences a m o n g the groups related to the l e v e l s Of stress e x p e r i e n c e d , w i t h the e x c e p t i o n o f scores o n the p e r f e c t i o n i s m subscales o f the p s y c h o s o c i a l stressors measure. O n the p e r f e c t i o n i s m subscale e x c e p t i o n a l l y gifted girls reported s t a t i s t i c a l l y significant h i g h e r l e v e l s o f p e r f e c t i o n i s m than girls i n the a c a d e m i c a l l y average group. T h e r e was also a trend for the e x c e p t i o n a l l y gifted female group to e x p e r i e n c e h i g h e r l e v e l s o f p e r f e c t i o n i s m than the gifted female group, although this was not f o u n d to be statistically significant.  S c o r e s o f p e r f e c t i o n i s m were h i g h e r a m o n g each g r o u p for f e m a l e versus m a l e  subjects. P a r k e r and M i l l s (1996) investigated the i n c i d e n c e o f p e r f e c t i o n i s m a m o n g 6 0 0 grade six students i d e n t i f i e d as " a c a d e m i c a l l y talented" i n c o m p a r i s o n to a g r o u p o f 4 1 8 peers f r o m a general c o h o r t w i t h s i m i l a r s o c i o e c o n o m i c status u s i n g the M u l t i d i m e n s i o n a l P e r f e c t i o n i s m S c a l e (Frost, M a r t e n , L a h a r t & R o s e n b l a t e , 1990 as c i t e d i n P a r k e r and M i l l s , 1996). P a r k e r and M i l l s (1996) c h a l l e n g e the n o t i o n that a h i g h e r i n c i d e n c e o f p e r f e c t i o n i s m exists a m o n g gifted students based o n e m p i r i c a l f i n d i n g s rather than based o n anecdotal reports. Q u a n t i t a t i v e f i n d i n g s suggest that the m e a n scores o f the t w o groups were s i m i l a r a n d n o statistical difference between perfectionistic types between the t w o groups was f o u n d . P a r k e r a n d M i l l s (1996) assert that anecdotal reports suggesting h i g h rates o f p e r f e c t i o n i s m and m o r e m a l a d a p t i v e perfectionistic tendencies a m o n g gifted students m a y be the result o f differential l a b e l i n g o f s i m i l a r b e h a v i o u r based o n p r e c o n c e i v e d assumptions.  40  Qualitative Research in the Giftedness and Eating Disorder Fields L i t e r a t u r e relating to disordered eating, giftedness, and c o u n s e l l i n g address the need for q u a l i t a t i v e data to p r o v i d e the l e v e l o f depth a n d m e a n i n g associated w i t h u n d e r s t a n d i n g l i v e d e x p e r i e n c e (Garrett, 1997; H o s k i n s , 2 0 0 2 ; K u n k e l & C h a p a , 1992; M a t o f f & M a t o f f , 2 0 0 1 ) . T h e e x p e r i e n c e o f an eating disorder is not w e l l d o c u m e n t e d i n q u a l i t a t i v e literature, a l t h o u g h m a n y qualitative studies e x a m i n e related experiences, such as those o f parents or health care p r o v i d e r s w h o care for those w h o experience an eating d i s o r d e r (e.g. J a r m a n , S m i t h & W a l s h , 1997; H o s k i n & L a m , 2 0 0 1 ) . S p e c i f i c to those w h o d o struggle w i t h eating disorders, q u a l i t a t i v e studies e x a m i n i n g the experience o f b i n g e i n g and p u r g i n g or r e c o v e r y are m o r e c o m m o n (e.g. Garrett, 1997; M a t o f f & M a t o f f , 2 0 0 1 ; Pettersen & R o s e n v i n g e , 2 0 0 2 ) . F e w p u b l i s h e d studies are s p e c i f i c to a n s w e r i n g the questions: w h a t is the l i v e d e x p e r i e n c e o f an eating disorder and what is the m e a n i n g o f that e x p e r i e n c e ?  T h e r e also  appears to be a scarcity i n studies referring to the l i v e d experience o f gifted i n d i v i d u a l s or w h i c h e x p l o r e giftedness or related topics through qualitative means. F e w studies i n gifted literature address p s y c h o l o g i c a l f u n c t i o n i n g or distress a m o n g gifted adolescents u s i n g qualitative m e t h o d o l o g y .  Qualitative Gifted Research T h e e x p e r i e n c e o f giftedness itself and depression a m o n g gifted adolescents has been researched u s i n g p h e n o m e n o l o g i c a l m e t h o d o l o g y ( J a c k s o n , 1998; K u n k e l & C h a p a 1992; K u n k e l , C h a p a , Patterson & W a l l i n g , 1995). K u n k e l and C h a p a (1992) describe the e x p e r i e n c e o f giftedness a m o n g 85 seventh, e i g h t h and n i n t h grade adolescents p a r t i c i p a t i n g i n a gifted s u m m e r e n r i c h m e n t p r o g r a m . K u n k e l and C h a p a c o m m e n t o n the rarity o f  41  research that has "sought to understand and appreciate giftedness as an i n t e r n a l l y e x p e r i e n c e d p h e n o m e n o n " . T h e n e e d to focus o n the construct o f giftedness as a gifted p o p u l a t i o n experiences it, rather than as researchers define it, is e m p h a s i s e d (Introduction section, f 2). G a l b r a i t h (1985) c o n d u c t e d a study entitled, " T h e eight great gripes o f gifted k i d s " , w h i c h p r o v i d e s a f o u n d a t i o n for K u n k e l and C h a p a ' s research (as c i t e d i n K u n k e l & C h a p a , 1992). G a l b r a i t h (1985) p r o v i d e d little i n f o r m a t i o n r e g a r d i n g m e t h o d o l o g y u s e d i n i n t e r v i e w s a n d surveys w i t h o v e r 4 0 0 gifted c h i l d r e n a n d adolescents, ages 7-18 i n gifted p r o g r a m throughout the U n i t e d States. K u n k e l a n d C h a p a (1992), asked participants to r e s p o n d i n w r i t i n g to a neutral p r o b e " W h a t is it l i k e to be g i f t e d ? " Responses were a n a l y z e d i n relation to G a l b r a i t h ' s o r i g i n a l themes w h i c h i n c l u d e d : c o n f u s i o n , b o r e d o m , perfection, r i d i c u l e , l o n e l i n e s s , uniqueness, b u r d e n e d a n d altruistic. W i t h o u t p r o b i n g i n relation to specific aspects o f the gifted e x p e r i e n c e , m o r e than h a l f o f the sample noted c o n f u s i o n about giftedness a n d its m e a n i n g i n their l i v e s . T h i s w a s seen as an o v e r r i d i n g theme i n their responses.  F r u s t r a t i o n w i t h the  expectations o f others a n d w i t h a need for perfection was reported b y one t h i r d o f the s a m p l e . A l t r u i s m , concerns about the w o r l d ' s p r o b l e m s , b o r e d o m and feelings o f b e i n g o v e r w h e l m e d w e r e reported less frequently w i t h o u t s p e c i f i c a l l y b e i n g addressed than w o u l d be suggested b y G a l b r a i t h ' s f i n d i n g s . S h a m e and i s o l a t i o n w e r e a d d i t i o n a l themes d e v e l o p e d f r o m the student responses that w e r e not referred to i n G a l b r a i t h ' s o r i g i n a l study. K u n k e l , C h a p a , Patterson a n d W a l l i n g (1995) e x p a n d o n the w o r k presented b y K u n k e l a n d C h a p a (1992) b y d e v e l o p i n g a concept m a p o f the e x p e r i e n c e o f giftedness b a s e d o n the same data. T h e same participants were asked to contribute to a c o n c e p t u a l m a p u s i n g responses generated f r o m the o r i g i n a l w r i t t e n response to the probe " W h a t is it l i k e to be  42  g i f t e d ? " N i n e t y - s i x m e a n i n g units were arranged i n clusters t h r o u g h c a r d sort b y participants a n d f r o m concept m a p p i n g procedures. T h e clusters i n c l u d e d : i n t e l l e c t u a l superiority, s o c i a l s u p e r i o r i t y , self-satisfaction, skillfulness, respect f r o m others, s o c i a l stress, estrangement, and c o n f o r m i t y . J a c k s o n (1998) investigated the l i v e d experience o f depression a m o n g a s a m p l e o f gifted adolescents. T h e p r o b l e m o f interest is d e f i n e d as w a n t i n g to d o c u m e n t "the scope and nature o f the depressive e x p e r i e n c e " a m o n g gifted adolescents, and to address i m p l i c a t i o n s for practice (Introduction section, 16).  Increased rates o f s u i c i d e a n d i n c r e a s e d r i s k o f  depression are c i t e d and p r o v i d e a strong rationale and basis for this study. A l t h o u g h not e x p l i c i t l y stated, the i m p l i c i t research questions c a n be seen as h o w the l i v e d e x p e r i e n c e o f depression is manifested a m o n g this p o p u l a t i o n , a n d whether the l i v e d e x p e r i e n c e is q u a l i t a t i v e l y different f r o m the n o r m . A p h e n o m e n o l o g i c a l i n q u i r y r e v e a l e d the "essence" o f the core structure and l i v e d experience o f depression a m o n g this p o p u l a t i o n i n a s a m p l e o f 10 participants ages 16-19. I Q scores served as a m i n i m u m requirement for p a r t i c i p a t i o n yet other relevant factors s u c h as a b i l i t y to articulate the experience and e m o t i o n a l intensity w e r e c o n s i d e r e d . T h e participants were self-referred as h a v i n g e x p e r i e n c e d d e p r e s s i o n , yet the l e v e l o f severity and d u r a t i o n v a r i e d s i g n i f i c a n t l y a m o n g the participants. O n e question was a s k e d i n the b e g i n n i n g o f the i n t e r v i e w , " P l e a s e describe for m e y o u r e x p e r i e n c e w i t h the less than p o s i t i v e e m o t i o n a l state c o m m o n l y k n o w n as d e p r e s s i o n " . T h e participants were g i v e n the o p p o r t u n i t y to t e l l their stories and the p h e n o m e n o n w a s " a l l o w e d to speak for i t s e l f (f 1, D a t a Sources S e c t i o n ) . T h e results o f this study suggest that the depressive experience o f this p o p u l a t i o n i n v o l v e d the i n i t i a l stage o f the depressive state, the state itself and the i m p a c t . C o r e themes i d e n t i f i e d t h r o u g h J a c k s o n ' s a n a l y s i s w e r e  43  that e m o t i o n and affect are central to the experience o f the gifted adolescent, a n d that these needs i n c l u d e the n e e d for k n o w l e d g e , c o m m u n i o n and e x p r e s s i o n . T h e s e themes p r o v i d e a significant l e v e l o f i n s i g h t into the f u n c t i o n i n g , d e v e l o p m e n t and needs o f the gifted adolescent. J a c k s o n and Peterson (2003) e x a m i n e the "nature and extent" o f depressive disorders as they related to h i g h l y gifted adolescents through the use o f p h e n o m e n o l o g i c a l a n a l y s i s , focus g r o u p and c l i n i c a l data (p. 175). It is argued that this p o p u l a t i o n frequently m a s k s depression f r o m others, a n d that u n i q u e qualitative differences o f the e x p e r i e n c e o f depression and c o n t r i b u t i n g m a y occur. T h e u t i l i t y o f quantitative measures to determine genuine depressive disorders a m o n g h i g h l y gifted adolescents is questioned. A r e v i e w o f general literature o n depressive disorders, literature and c l i n i c a l e v i d e n c e related to depression a m o n g h i g h l y gifted adolescents, o u t l i n e o f c o m m o n traits a m o n g gifted adolescent p o p u l a t i o n s a n d case studies, and results o f a p h e n o m e n o l o g i c a l i n q u i r y are presented. S u s c e p t i b i l i t y to depression is seen as relating to "poorness o f f i t " i n their e n v i r o n m e n t and a m o n g peers. S o c i o - e m o t i o n a l and intellectual needs m a y not be " m i r r o r e d " , or their perceptions o f the w o r l d m a y not fit w i t h those a r o u n d t h e m (p. 178). H e i g h t e n e d s e n s i t i v i t y a n d m a s k i n g o f depressive s y m p t o m s or u n d e r l y i n g f e e l i n g are related to feelings o f shame and a fear o f h o w others m a y be affected b y their e x p r e s s i o n o f depression.  Qualitative Research on Eating  Disorders  D e s p i t e the v a s t n u m b e r o f articles that address eating disorders i n the literature, f e w studies refer to the l i v e d experience o f eating disorders f r o m the perspective o f the  44  i n d i v i d u a l s e x p e r i e n c i n g the p h e n o m e n o n . T h e experience o f eating d i s o r d e r r e c o v e r y appears to h a v e r e c e i v e d s o m e attention i n recent literature (e.g. Garrett, 1997; M a t o f f & M a t o f f , 2 0 0 1 ; Pettersen & R o s e n v i n g e , 2002) although the e x p e r i e n c e o f d i s o r d e r e d eating i t s e l f is not addressed s p e c i f i c a l l y t h r o u g h p u b l i s h e d qualitative research. M a n y studies refer to the n e e d for qualitative research that c a n speak m o r e f u l l y to the h u m a n e x p e r i e n c e rather than r i s k factors, e t i o l o g y or treatment outcomes related to d i s o r d e r e d eating (e.g., H o s k i n s , . 2 0 0 2 ; M a t o f f & M a t o f f , 2 0 0 1 ) . E a t i n g disorders present a s i g n i f i c a n t struggle and process for i n d i v i d u a l s w h o experience them, and the i n f o r m a t i o n and s h a r i n g that c a n be g a i n e d f r o m these i n d i v i d u a l s about their h u m a n experience s h o u l d not be o v e r l o o k e d , n o r its p o w e r underestimated. Garrett (1997) refers to the m a n y aspects o f the e x p e r i e n c e o f eating disorders that cannot be, or are not, t h o r o u g h l y e x a m i n e d t h r o u g h quantitative means, and argues that there exists a l a c k o f indicators o f p o s i t i v e outcomes and r e c o v e r y i n current research. It is suggested that these indicators o f r e c o v e r y m a y o n l y be e l i c i t e d b y the stories o f those e x p e r i e n c i n g and r e c o v e r i n g f r o m eating disorders. Garrett investigated the stories o f r e c o v e r y o f 3 2 female participants w h o were i n v a r i o u s stages o f r e c o v e r y f r o m A n o r e x i a , u s i n g p h e n o m e n o l o g i c a l m e t h o d o l o g y f r o m a s o c i o l o g i c a l perspective. C e r t a i n elements associated w i t h r e c o v e r y a m o n g the participants i n c l u d e d 1) a b a n d o n i n g o b s e s s i o n w i t h f o o d and w e i g h t , c o n c o m i t a n t w i t h a c r i t i c a l understanding o f s o c i a l pressure, 2) h a v i n g a sense that their l i v e s were m e a n i n g f u l , 3) b e l i e v i n g that they were w o r t h w h i l e , a n d that the different aspects o f themselves were part o f a w h o l e person, 4) b e l i e v i n g s t r o n g l y that they w o u l d never return to self-starvation and 5) m e n t i o n i n g s p i r i t u a l i t y as a source o f m e a n i n g .  45  M a t o f f and M a t o f f (2001) assert that the process and experience o f d i s o r d e r e d eating and r e c o v e r y f r o m a c l i e n t ' s account "has potential to be a r i c h source o f u n t a p p e d i n f o r m a t i o n . . . " w h i c h m a y contribute to greater understanding and have i m p l i c a t i o n s for treatment (p. 4 4 ) . B a s e d o n qualitative data o b t a i n e d through a structured, o p e n - e n d e d i n t e r v i e w , the e x p e r i e n c e o f r e c o v e r y for one participant d i a g n o s e d w i t h A n o r e x i a N e r v o s a ( b i n g e / p u r g i n g type) was e x p l o r e d . D e t a i l s o f data analysis are not p r o v i d e d , a l t h o u g h c o p i n g strategies, stages and elements o f r e c o v e r y s u c h as " s e e k i n g p r o f e s s i o n a l h e l p , a v o i d i n g destructive relationships and g a i n i n g e m p o w e r m e n t to battle the relentless i n n e r c r i t i c that o v e r s h a d o w s d a i l y l i f e " are d e s c r i b e d (p. 4 7 ) . W i c k s t e e d (2002) explores issues related to c o n t r o l i n those w h o e x p e r i e n c e e a t i n g disorders t h r o u g h a qualitative approach. W i c k s t e e d suggests that a l t h o u g h s e e k i n g c o n t r o l is often a prevalent theme i n the experience o f disordered eating it has o n l y " d e v e l o p e d anecdotal l i n k a g e " (p. 4 7 5 ) . , A s part o f a p i l o t study i n v o l v i n g 3 2 i n d i v i d u a l s , ages 14-56, e m p l o y i n g qualitative analysis o f data c o n t a i n e d through e m a i l contact, t w o m a i n themes were e l u c i d a t e d . A l t h o u g h the m e t h o d o l o g y used to garner these themes is not w e l l articulated e m e r g i n g themes i n c l u d e d : 1) " v a r i o u s contexts i n w h i c h the i n d i v i d u a l s h a d l i m i t e d c o n t r o l / a u t o n o m y o v e r l i f e " , s u c h as p e r s o n a l traumas, l o w self esteem a n d s e l f w o r t h associated w i t h the needs and perceptions o f others and 2) " u n p r e d i c t a b i l i t y o f c o n t e x t u a l situations c o m p a r e d w i t h the p r e d i c t a b i l i t y o f f o o d " both as related to a u t o n o m y or s e e k i n g c o n t r o l and for c o m f o r t (p. 4 7 8 ) .  46  The Literature Reviewed as it Relates to the Current Study The literature reviewed forms the basis of this study, the research questions, and methodology used. Although, the lack of consensus on a concrete definition or understanding of giftedness complicates this research project, the literature reviewed provides a basis for considering current conceptualizations of giftedness and commonly associated characteristics. The suggestion that qualitative research can add much to the current understanding of gifted individuals also contributes to the study's rationale and chosen methodology (e.g., Coleman & Cross, 2000; Jackson & Peterson, 2003). The lack of specific literature that relates to gifted individuals who experience eating disorders, and the absence of research studies that address this topic, represents a gap in the current state of knowledge. Inferences were drawn from the reviewed literature in both the fields of giftedness and eating disorders to identify characteristics and risk factors that intersect both areas. The areas of self-esteem, self-concept, and perfectionism were highlighted as particularly salient themes in both gifted and eating disorder literature. These characteristics and literature that relates to adolescents, and more specifically to gifted adolescents who experience eating disorders, provide a foundation to discuss the findings that emerged from this study. Several researchers in both giftedness and eating disorders address the need for qualitative research to further explore the subjective understanding of those who live these experiences. Qualitative research related to gifted individuals, both in general and in studies specific to depression, provides both insight and the depth of understanding similar to which the current study aspires. Qualitative research related to eating disorders currently lacks contributions that reveal what the experience of an eating disorder is like for those who  47 experience it from a subjective perspective. The combination of all of these factors prompted me to explore qualitatively the experience of eating disorders among gifted adolescents, and the meaning that is ascribed to that experience.  48  C H A P T E R III Methodology  P h e n o m e n o l o g y requires a k i n d o f w i t h d r a w a l f r o m the w o r l d , and a w i l l i n g n e s s to l a y aside e x i s t i n g beliefs and theories. T h i s is r i s k y , and takes an act o f courage. It c a n be v i e w e d as a j o u r n e y d u r i n g w h i c h one leaves f a m i l i a r places a n d then returns a n d sees these places i n a fresh l i g h t . ( M c L e o d , 2 0 0 1 , p . 37)  T h e m e t h o d o f i n q u i r y used for this study is d e s c r i p t i v e , p h e n o m e n o l o g i c a l a n d based w i t h i n a q u a l i t a t i v e p a r a d i g m . T h i s research d e s i g n was chosen for the u t i l i t y i n a d d r e s s i n g the core a n d c o m m o n themes o f the l i v e d experience o f the p h e n o m e n o n o f interest. A p h e n o m e n o l o g i c a l study p r o v i d e s the opportunity to e x p l o r e the research questions at the depth and l e v e l o f m e a n i n g , through w h i c h I h o p e d to describe the e x p e r i e n c e o f eating disorders a m o n g gifted adolescents. C o l e m a n and C r o s s (2000) s p e c i f i c a l l y c a l l for research addressing the l i v e d experience o f gifted i n d i v i d u a l s , and cite p h e n o m e n o l o g y as a v a l u a b l e m e t h o d to e x p l o r e giftedness, the s o c i o - e m o t i o n a l aspects o f gifted i n d i v i d u a l s ' e x p e r i e n c e , and the m e a n i n g o f that experience. T h e present study explores and describes q u a l i t a t i v e l y the e x p e r i e n c e o f an eating d i s o r d e r amOng a s a m p l e o f gifted female adolescents. S i x y o u n g w o m e n p a r t i c i p a t e d i n p h e n o m e n o l o g i c a l i n t e r v i e w s through w h i c h they d e s c r i b e d their p e r s o n a l e x p e r i e n c e o f an eating disorder. T h e i n t e r v i e w s were subsequently transcribed and a n a l y z e d , r e v e a l i n g ten themes d e s c r i b i n g the participants' experience and their associated m e a n i n g . E a c h t h e m e and its associated sub-themes were elaborated o n and supported t h r o u g h t h i c k d e s c r i p t i o n a n d i n t e r v i e w excerpts i n the presentation o f the research f i n d i n g s .  49  Research  Questions  The research questions that guided this study were designed to effectively address its purpose and rationale. These research questions included: •  What is the lived experience and meaning of disordered eating among gifted female adolescents?  •  What are the core and common themes, or the essence of the experience of an eating disorder, among the participants?  •  What aspects of giftedness are represented in the lived experience of disordered eating among gifted adolescents?  Definitions Both the major constructs referred to in this study, "eating disorder" and "gifted", are difficult to define precisely. Operational definitions used throughout this study include:  Gifted Adolescent:  An individual age 15-18 who manifests heightened cognitive and  emotional functioning as measured by IQ tests and/or anecdotal reports from trained and experienced professionals who specialize in either the gifted or eating disorders field. Gifted adolescent may also be defined as an adolescent age 15-18 who has been defined by the educational system as gifted as per the B.C. Ministry of Education guidelines (2002) for definition, identification and assessment of gifted students. The B.C Ministry of Education guidelines consider a student gifted when "she/he possesses demonstrated or potential abilities that give evidence of exceptionally high capability with respect to intellect,  50  c r e a t i v i t y or the s k i l l s associated w i t h specific d i s c i p l i n e s . Students w h o are gifted often demonstrate outstanding abilities i n m o r e than one area. T h e y m a y demonstrate extraordinary intensity o f focus i n their particular areas o f talent or interest" ( D e f i n i t i o n S e c t i o n , f 1). Giftedness:  "Asynchronous development i n w h i c h advanced cognitive abilities and  h e i g h t e n e d intensity c o m b i n e to create inner experiences and awareness that are q u a l i t a t i v e l y different f r o m the n o r m . T h i s a s y n c h r o n y increases w i t h higher i n t e l l e c t u a l c a p a c i t y " ( C o l u m b u s G r o u p , 1991 as cited i n J a c k s o n , 1995; S i l v e r m a n , 1998, D e f i n i t i o n s o f Giftedness S e c t i o n , <j[ 4). Giftedness also includes "demonstrated or potential a b i l i t i e s that g i v e e v i d e n c e o f e x c e p t i o n a l l y h i g h c a p a b i l i t y w i t h respect to intellect, c r e a t i v i t y or the s k i l l s associated w i t h s p e c i f i c d i s c i p l i n e s " ( B . C M i n i s t r y o f E d u c a t i o n , 2 0 0 2 , D e f i n i t i o n S e c t i o n , <J[  Eating Disorder:  D e f i n e d b y c r i t e r i a for A n o r e x i a N e r v o s a , B u l i m i a N e r v o s a or  E a t i n g D i s o r d e r N o t O t h e r w i s e S p e c i f i e d i n the D S M - I V - R ( A P A , 2 0 0 0 ) . Please see A p p e n d i x A for diagnostic c r i t e r i a o f A n o r e x i a N e r v o s a , B u l i m i a N e r v o s a , a n d E a t i n g D i s o r d e r N o t O t h e r w i s e specified.  Descriptive  Phenomenology as a Method  G i o r g i (1985) refers to the o r i g i n a l w r i t i n g s o f H u s s e r l ( 1 9 7 0 / 1 9 0 0 ) , noted as the "founder o f p h e n o m e n o l o g y " , to describe the " g u i d i n g t h e m e " o f p h e n o m e n o l o g y as g o i n g ' b a c k to the things themselves' (p. 8). D e s c r i p t i v e p h e n o m e n o l o g i c a l methods s u c h as those d e s c r i b e d b y G i o r g i ( 1 9 8 5 , 1997), G i o r g i and G i o r g i (2003) and K a r l s s o n (1993) seek to i l l u m i n a t e the essential structure or essence o f a p h e n o m e n o n and the m e a n i n g that is  51  a s c r i b e d to the p h e n o m e n o n b y the participants. T h e essence o f a g i v e n p h e n o m e n o n presented is d e s c r i p t i v e , qualitative and answers the questions o f " w h a t " a n d " h o w " rather than " w h y " ( K a r l s s o n , 1993). G i o r g i (1992) responds to c o n c e r n that d e s c r i p t i v e p h e n o m e n o l o g y is not able to address the m e a n i n g structure o f p h e n o m e n o n . G i o r g i suggests that b y a l l o w i n g the p h e n o m e n o n to be d e s c r i b e d as it presents itself f r o m the participants, this " d i s c o v e r y o r i e n t e d " perspective w i l l a l l o w m e a n i n g to emerge. D e s c r i p t i o n s themselves are seen as " l o a d e d w i t h concrete expressions o f m e a n i n g " (p. 124). G i o r g i argues that d e s c r i p t i v e p h e n o m e n o l o g y i n v o l v e s the " c l a r i f i c a t i o n o f m e a n i n g o f objects p r e c i s e l y as they are e x p e r i e n c e d " and that it is not necessary to go b e y o n d the descriptions to b e s t o w m e a n i n g w h i c h m a y i n v o l v e the d o m a i n o f interpretive p h e n o m e n o l o g y (p. 122). H e argues that p a r t i c i p a n t s ' interpretation o f their experience does not have to be interpreted to h a v e m e a n i n g and c a n instead be described. D e s c r i b i n g the p a r t i c i p a n t ' s awareness o f the m e a n i n g is seen as important as a search for a u n i v o c a l m e a n i n g interpreted b y the researcher that m a y o c c u r i f w e seek to m o v e b e y o n d what the data present. K a r l s s o n (1993) outlines his e m p i r i c a l , p h e n o m e n o l o g i c a l , p s y c h o l o g i c a l a p p r o a c h ( E P P - m e t h o d ) w i t h b o t h theoretical support and concrete illustrations o f the m e t h o d . T h e steps o f the procedure are v e r y s i m i l a r to those o u t l i n e d as d e s c r i p t i v e p h e n o m e n o l o g i c a l m e t h o d o l o g y b y G i o r g i (1985), and G i o r g i and G i o r g i (2003). K a r l s s o n (1993) e m p h a s i z e s the v a l u e o f " l i f e w o r l d e x p e r i e n c e s " and the need for r i g o r o u s m e t h o d o l o g y to u n c o v e r the 'essence' or ' m e a n i n g structure' o f the p h e n o m e n o n o f interest (p. 4 5 ) . I h a v e c h o s e n d e s c r i p t i v e p h e n o m e n o l o g i c a l methods to a l l o w the p a r t i c i p a n t s ' data and the m e a n i n g they ascribe to their o w n l i v e d experiences to emerge as they present  52  themselves. I b e l i e v e that d e s c r i p t i o n o f experiences is not w i t h o u t m e a n i n g a n d has significant v a l u e i n its o w n right.  Phenomenological  Interviewing  M c L e o d (2001) suggest the p h e n o m e n o l o g i s t ' s task is " i m m e n s e " a n d that t o o l s a v a i l a b l e are " o u r e x p e r i e n c e itself, and the language w h i c h has e v o l v e d w i t h i n a culture to account for that e x p e r i e n c e " (p. 36). In response to c o m m o n objections a n d s k e p t i c i s m about the u t i l i t y or o b j e c t i v i t y o f qualitative research i n t e r v i e w i n g , K v a l e (1994) defines the purpose o f the q u a l i t a t i v e i n t e r v i e w as to "gather descriptions o f the l i f e - w o r l d o f the i n t e r v i e w e e w i t h the intention o f interpreting the m e a n i n g o f the d e s c r i b e d p h e n o m e n o n " (p. 149). K v a l e (1983) describes m a n y o f the central aspects o f qualitative research i n t e r v i e w i n g w h i c h relate to d e s c r i p t i v e p h e n o m e n o l o g i c a l research. A c c o r d i n g to K v a l e (1983), the subject matter o f the qualitative research i n t e r v i e w is the life w o r l d o f the participant, and h o w he/she experiences it. T h e g o a l is to o b t a i n as c o m p l e t e a d e s c r i p t i o n as p o s s i b l e o f the i n t e r v i e w e e ' s life w o r l d or e x p e r i e n c e related to the p h e n o m e n o n e x p e r i e n c e d . T h e purpose is to understand and describe the m e a n i n g o f c o r e and c o m m o n themes i n the experience. T h e qualitative research i n t e r v i e w must a i m to be " p r e s u p p o s i t i o n l e s s " i n the sense that the i n t e r v i e w e r must attend to the i n t e r v i e w e e ' s e x p e r i e n c e w i t h openness and a " c r i t i c a l consciousness o f his o w n p r e s u p p o s i t i o n s " (p. 176). K v a l e also suggests that the qualitative research i n t e r v i e w is an interpersonal interaction b e t w e e n t w o p e o p l e and c a n be i n f l u e n c e d b y the s e n s i t i v i t y o f the i n t e r v i e w e r to the participant and subject matter. T h i s s e n s i t i v i t y m a y cause tension b e t w e e n the need to r e m a i n " p r e s u p p o s i t i o n l e s s " and the role o f the i n t e r v i e w e r i n o b t a i n i n g an in-depth  53  d e s c r i p t i o n o f the p a r t i c i p a n t ' s experience. T h e requirement o f b r a c k e t i n g and "deliberate c o n s c i o u s n a i v e t e " o n the part o f the i n t e r v i e w e r must be attended to (p. 178).  Bracketing: Rationale and Procedure W h e n it is s a i d that w i t h i n the r e d u c t i o n e v e r y t h i n g that presents i t s e l f is to be a c c o u n t e d for p r e c i s e l y as it presents itself, it is strategy d e v i s e d to counteract the p o t e n t i a l l y b i a s e d effects o f past experience. W h e n w e encounter f a m i l i a r objects w e tend to see t h e m t h r o u g h f a m i l i a r eyes and thus often m i s s seeing n o v e l features o f f a m i l i a r s i t u a t i o n s . . . . E v e n i f objects turn out to be p r e c i s e l y as w e first thought, it is m o r e r i g o r o u s to g i v e nuances and 'taken for granted' aspects a c h a n c e to s h o w themselves, because p h e n o m e n o l o g i s t s do want the totality to be a c c o u n t e d for. (Giorgi & G i o r g i , 2003, p. 249)  S u s p e n d i n g p r i o r k n o w l e d g e and beliefs related to the p h e n o m e n o n o f interest, or b r a c k e t i n g is a c h a l l e n g i n g task and m a y i n fact represent an "act o f c o u r a g e " as suggested b y M c L e o d ( 2 0 0 1 , p . 37). D e s p i t e the challenges, and the need to engage w i t h the data i n this w a y , b r a c k e t i n g r e m a i n s an essential and necessary element o f p h e n o m e n o l o g i c a l data analysis. A s h w o r t h (1996) refers to the h i s t o r i c a l foundations and i m p o r t a n c e o f b r a c k e t i n g to p h e n o m e n o l o g i c a l research.  T h e fact that p h e n o m e n o l o g i c a l p s y c h o l o g y is a " r a d i c a l l y  interpersonal p r o c e s s " is noted i n c o n j u n c t i o n w i t h the p r e m i s e that b r a c k e t i n g r e m a i n s a c r i t i c a l and " i n d i s p e n s a b l e m e t h o d o l o g i c a l p r i n c i p l e " o f p h e n o m e n o l o g y (Introduction S e c t i o n , f 6). In as m u c h as it is p o s s i b l e , p r i o r assumptions about the p h e n o m e n o n m u s t be  54  put aside to a l l o w the p h e n o m e n o n to be d e s c r i b e d " i n its a p p e a r i n g " ( A s h w o r t h , 1996, I n t r o d u c t i o n S e c t i o n , f 6). A n n s t o o s (1985) suggests that b r a c k e t i n g i n p h e n o m e n o l o g y does not represent a "disinterest o f the researcher" i n the participants' l i v e d e x p e r i e n c e o r the p h e n o m e n o n but rather a suspension o f a l l o f interests, beliefs or p r e c o n c e i v e d ideas o f the p h e n o m e n o n . T h r o u g h b r a c k e t i n g the "danger o f f i n d i n g o n l y what one expects to see" is lessened (p. 91). A s h w o r t h (1996) suggests that the c r i t e r i o n o f b r a c k e t i n g i s : " i f the m a i n t e n a n c e o f a g i v e n type o f a s s u m p t i o n w o u l d subvert entry into the l i f e - w o r l d , s u c h p r e s u p p o s i t i o n s must be set a s i d e " ( C o n c l u s i o n S e c t i o n , fl).  T h e difficulties and challenges o f m e e t i n g this  requirement are c o n s i d e r e d , yet g u i d e d b y the rationale o f a l l o w i n g the c o m m u n i c a t i o n o f d e s c r i p t i o n s o f the p h e n o m e n o n as the participants present t h e m . T h r o u g h d e c l a r a t i o n and self-reflection o f presuppositions that e x i s t e d for the researcher p r i o r to the participants' i n t e r v i e w s , and those that e m e r g e d throughout the i n t e r v i e w and data a n a l y s i s processes, those w h o interpret the f i n d i n g s m a y j u d g e f o r themselves h o w those presuppositions i n f l u e n c e d the presented f i n d i n g s . G i o r g i a n d G i o r g i (2003) address the n o t i o n o f b r a c k e t i n g t h r o u g h c o n s i d e r a t i o n o f H u s s e r l ' s p h e n o m e n o l o g i c a l r e d u c t i o n ( 1 9 0 0 / 1 9 7 0 ; 1913/1983 as c i t e d i n G i o r g i & G i r o g i , 2 0 0 3 ) . T h e p h e n o m e n o l o g i c a l reductions are d e s c r i b e d as an attitude rather than as a s p e c i f i c set o f procedures. T h e "great c o n f u s i o n " related to this first step i n p h e n o m e n o l o g y appears to be reflected i n the l a c k o f c l a r i t y s u r r o u n d i n g it, and also c o n t r o v e r s y as to whether these reductions are p o s s i b l e (p. 245). G i o r g i and G i o r g i differentiate b e t w e e n s c i e n t i f i c p h e n o m e n o l o g i c a l r e d u c t i o n and transcendental p h e n o m e n o l o g i c a l r e d u c t i o n , and suggest these t w o concepts contribute to the c o n f u s i o n s u r r o u n d i n g r e d u c t i o n i n the H u s s e r l i a n sense.  55  T h e y (2003) m a i n t a i n that transcendental is " w h o l l y p h i l o s o p h i c a l " , and that instead " p s y c h o l o g i c a l s u b j e c t i v i t y " is o f interest to, and s h o u l d guide, p s y c h o l o g i c a l a n a l y s i s (p. 245). K a r l s s o n (1993) p r o v i d e s some c l a r i t y to the issues o f p h e n o m e n o l o g i c a l p s y c h o l o g i c a l reductions and transcendental r e d u c t i o n as referred to b y H u s s e r l . B o t h p h e n o m e n o l o g i c a l p s y c h o l o g i c a l and transcendental r e d u c t i o n are d e s c r i b e d as a "break w i t h o u r natural attitude" and a "non-reflective b e l i e f i n the transcendental w o r l d " ( K a r l s s o n , 1993, p . 4 8 ) . T r a n s c e n d e n t a l r e d u c t i o n is m o r e c o m p l e x than p s y c h o l o g i c a l r e d u c t i o n a n d i n v o l v e s p u t t i n g aside a l l b e l i e f i n the transcendental w o r l d and its existence at a p h i l o s o p h i c a l l e v e l ( K a r l s s o n , 1993). G i o r g i a n d G i o r g i (2003) suggest that transcendental p h e n o m e n o l o g i c a l r e d u c t i o n is less useful i n h u m a n sciences, and also suggest that it is the u t i l i t y o f s c i e n t i f i c p h e n o m e n o l o g i c a l r e d u c t i o n ( w h i c h H u s s e r l referred to as p s y c h o l o g i c a l r e d u c t i o n ) , that f o r m s the basis o f b r a c k e t i n g . T h r o u g h scientific or p s y c h o l o g i c a l reductions, the things that present themselves through the participants' experience are taken as they are. T h i s a l l o w s the p h e n o m e n o l o g i s t to see the totality o f the experience emerge ' f r e s h l y ' a n d w i t h ' d i s c i p l i n e d n a i v e t e ' rather than to see o n l y what they thought w o u l d be seen ( G i o r g i & G i o r g i , 2003, p. 249). K a r l s s o n (1993) also maintains that rather than "transcendental r e d u c t i o n " , " p a r t i a l p h e n o m e n o l o g i c a l r e d u c t i o n s " ( w h i c h G i o r g i refers to as the scientific p h e n o m e n o l o g i c a l reduction), w h e r e b y the researcher brackets a l l "theories, hypotheses, m o d e l s a n d s y s t e m s " w h i c h m a y e x p l o r e or seek to e x p l a i n the p h e n o m e n o n o f study, has s i g n i f i c a n t u t i l i t y (p. 80). T h i s l e v e l o f r e d u c t i o n a l l o w s for the research to " b e l i e v e i n " the text i n order to a n a l y z e it,  56  and w h i l e not repressing or d e n y i n g any p r i o r k n o w l e d g e or beliefs about the p h e n o m e n o n , that k n o w l e d g e or b e l i e f is to be brought to a "thematic l e v e l i n order to be a u t h e n t i c a l l y capable o f setting it a s i d e " (p. 82).  Bracketing of Researcher's Biases and Assumptions: Subjective  Considerations of the Researcher as a  Person  M y r o l e as a researcher was c l e a r l y stated p r i o r to e n g a g i n g i n the research i n t e r v i e w s . B r a c k e t i n g o f personal k n o w l e d g e a n d beliefs r e g a r d i n g the p h e n o m e n o n w e r e attended to t h r o u g h analysis o f the experience o f the participants. W h i l e this c a n n e v e r be c o m p l e t e l y a c h i e v e d , e x p o s i n g these biases a l l o w s the reader o f the report to determine f o r h i m o r h e r s e l f h o w " p u r e " the answers to the questions asked are. T h a t i s , he o r she c a n determine h o w m u c h they reflect the experience o f the participants rather than the beliefs o f the researcher ( C r e s w e l l , 1998; M a c l e o d , 2 0 0 1 ) . W h e n I began to engage i n the process o f i n t e r v i e w i n g , I needed to be w i l l i n g a n d able to put aside what I m a y b e l i e v e to be relevant to the p a r t i c i p a n t s ' e x p e r i e n c e . A d e t a i l e d f i e l d j o u r n a l was kept i n order to m o n i t o r m y awareness throughout the i n t e r v i e w a n d analysis processes, a n d a process o f g o i n g b a c k to this bracketed k n o w l e d g e a n d feelings w a s a c r u c i a l aspect o f a l l o w i n g the data and the p a r t i c i p a n t ' s experience o f the data to " s h o w i t s e l f for the subject" ( K a r l s s o n , 1993, p. 50). In an attempt to r e m a i n "presuppositionless", I o p e n l y d e c l a r e d m y biases a n d subjective assumptions p r i o r to e n g a g i n g i n the i n t e r v i e w a n d data a n a l y s i s procedures. T h r o u g h o u t the i n t e r v i e w a n d data analysis, I c o n t i n u e d to reflect b a c k o n those biases a n d assumptions through the reflective j o u r n a l . It d i d take courage to d o so, as the fear o f f i n d i n g  57  o n l y what I thought I m i g h t f i n d was present i n m y c o n s c i o u s n e s s . T h i s a l l o w e d m e to be m i n d f u l and m o r e r i g o r o u s throughout the process i n order to v a l i d a t e the f i n d i n g s a n d to ensure that the results are true to the experience o f the participants. B a s e d o n m y p e r s o n a l experience and subjective interpretations, r e v i e w o f the literature p e r t a i n i n g to disordered eating and giftedness, and p r o f e s s i o n a l e x p e r i e n c i n g w o r k i n g w i t h adolescents (both gifted and non-gifted) w h o e x p e r i e n c e d i s o r d e r e d eating, I i d e n t i f i e d several biases and assumptions that were c a r e f u l l y attended to a n d b r a c k e t e d throughout data c o l l e c t i o n and analysis. •  These presuppositions i n c l u d e d the f o l l o w i n g :  A l t h o u g h w e i g h t and f o o d preoccupations are often (though not a l w a y s ) p r e d o m i n a n t i n the e x p e r i e n c e o f d i s o r d e r e d eating, u n d e r l y i n g e m o t i o n a l a n d p s y c h o l o g i c a l issues are central to the experience.  •  A s p e c t s o f giftedness (e.g., a s y n c h r o n o u s d e v e l o p m e n t , s e n s i t i v i t y to the expectations and needs o f other, h i g h personal standards, p e r f e c t i o n i s m , e m o t i o n a l and i n t e l l e c t u a l o v e r e x c i t a b i l i t i e s ) m a y be present i n the l i v e d e x p e r i e n c e o f gifted adolescents w h o e x p e r i e n c e d i s o r d e r e d eating.  •  A d o l e s c e n t s , and p o s s i b l y to a greater extent gifted adolescents, w i l l be able to articulate the l i v e d experience o f d i s o r d e r e d eating, whether c u r r e n t l y e x p e r i e n c i n g d i s o r d e r e d eating or h a v i n g recently recovered.  •  A m o n g gifted adolescents, l a c k o f accurate m i r r o r i n g o f e m o t i o n a l intensity a n d awareness or i n t e l l e c t u a l a b i l i t y b y peers or f a m i l y m a y contribute to p s y c h o l o g i c a l v u l n e r a b i l i t i e s or distress.  •  D u r i n g adolescence, asynchronous d e v e l o p m e n t or b e i n g "out o f step" w i t h peers m a y be e s p e c i a l l y salient and contribute to p s y c h o l o g i c a l v u l n e r a b i l i t i e s or distress.  58 •  M a n y adolescents who experience disordered eating seem exceptionally bright and articulate, although a qualitative difference between the experience of disordered eating between gifted and non-gifted adolescents may exist.  •  In many instances, disordered eating is a coping mechanism through which adolescents manage psychological discomfort and pain.  •  Societal pressures and mixed messages (i.e. be powerful yet feminine) and family factors are involved in the development of disordered eating among gifted adolescent females.  Recruitment Potential subjects were approached through a letter of recruitment which was forwarded to them from professional treatment providers with expertise in psychotherapy, eating disorder treatment, counselling or education of gifted individuals or individuals experiencing eating disorders (for example: B . C . Children's Hospital eating disorder program and local community eating disorder treatment programs). Potential subjects were not directly approached, and instead were provided access to contact information should they choose to inquire further. Professionals were contacted by phone and/or through letters of contact delivered by mail or in person from the student researcher. Letters of contact outlined the purpose and nature of the study, participation criteria, procedures to be used, and contact information to answer any questions. Posted advertisements and email messages indicating recruitment information were forwarded to organizations that the student researcher is aware of or has contact with such as B . C Children's Hospital Eating Disorders program, community outpatient child and youth  59  eating disorders p r o g r a m s , the E a t i n g D i s o r d e r R e s o u r c e C e n t r e o f B r i t i s h C o l u m b i a , the E m i l y C a r r Institute, the G i f t e d C h i l d r e n ' s A s s o c i a t i o n o f B . C . , the D a i m o n Institute for the H i g h l y G i f t e d , S i m o n Fraser U n i v e r s i t y ' s C o u n s e l l i n g Centre, and l o c a l c o m m u n i t y outpatient eating d i s o r d e r treatment p r o g r a m s . W h e n potential participants m a d e contact w i t h the student researcher i n response to a posted advertisement at eating d i s o r d e r treatment facilities a letter o f contact was f o r w a r d e d to t h e m .  Participant  Selection  Procedures  T h e focus o f the study i n v o l v e d participants w h o had i n the past f i v e years e x p e r i e n c e d or w h o c u r r e n t l y experience an eating disorder as an adolescent (age 15-18). P a r t i c i p a n t s were selected based o n several c r i t e r i a that i n c l u d e d each o f these considerations: •  F e m a l e s w h o have experienced/experience disordered eating b e t w e e n the ages o f 15 and 18.  •  T h e e x p e r i e n c e o f disordered eating has o c c u r r e d w i t h i n the last 5 years.  •  H a v e r e c e i v e d treatment or c o u n s e l l i n g for D i s o r d e r e d E a t i n g .  •  P r e v i o u s c o g n i t i v e assessment y i e l d i n g I Q above 130 and/or m e m b e r s h i p i n an e d u c a t i o n a l gifted p r o g r a m and/or the o p i n i o n o f an expert p r o f e s s i o n a l that the participant meets c r i t e r i a for giftedness o u t l i n e d i n the study.  •  W i l l i n g n e s s and a b i l i t y to articulate their thoughts, perceptions a n d feelings about the e x p e r i e n c e o f disordered eating.  •  F r e e o f any p h y s i o l o g i c a l or p s y c h o l o g i c a l c o n d i t i o n that m a y s i g n i f i c a n t l y affect their a b i l i t y to articulate their experience (i.e. severe m a l n u t r i t i o n or m e d i c a l instability.)  •  A b l e to speak and understand E n g l i s h .  60  Participant  Characteristics  S i x gifted female adolescents w h o met the selection c r i t e r i a p a r t i c i p a t e d i n the i n t e r v i e w process. T h e s e s i x i n t e r v i e w s f o r m e d the basis o f data that w e r e a n a l y z e d , and the subsequent results. T w o other participants w h o d i d not meet a l l o f the s e l e c t i o n c r i t e r i a due to not s t r i c t l y m e e t i n g the giftedness c r i t e r i a or age requirements, also p a r t i c i p a t e d as p i l o t i n t e r v i e w participants. T h e s e t w o i n d i v i d u a l s were aware that that they d i d not f u l l y meet the requirements, yet i n q u i r e d i f they were able to h e l p at some l e v e l . T h e s e t w o i n t e r v i e w s were o f tremendous assistance i n g a i n i n g c o m f o r t and s k i l l w i t h the i n t e r v i e w p r o t o c o l and phenomenological interviewing. P a r t i c i p a n t s h a d a l l r e c e i v e d a d i a g n o s i s and been treated f o r A n o r e x i a N e r v o s a . T h i s represents an u n e x p e c t e d and interesting characteristic o f the s a m p l e , as the type o f eating disorder was not s p e c i f i e d i n recruitment or selection o f participants. A l l participants c o n t i n u e to r e c e i v e treatment and or support w i t h their eating d i s o r d e r or related p s y c h o l o g i c a l or adjustment issues. A l l but one o f the participants e x p l i c i t l y noted that they c o n t i n u e to struggle w i t h eating disorder d y n a m i c s . T h e r e m a i n i n g participant i n d i c a t e d that eating d i s o r d e r d y n a m i c s are not far f r o m her current experience and m a n y o f the related u n d e r l y i n g issues c o n t i n u e to be present i n her current experience and are addressed i n her treatment. E a c h participant was between the ages o f 16 and 2 0 w h e n i n t e r v i e w e d , but h a d e x p e r i e n c e d A n o r e x i a between the ages o f 15-18. F i v e o f the s i x participants h a d been h o s p i t a l i z e d as a result o f their eating disorder, a n d a l l h a d e x p e r i e n c e d s i g n i f i c a n t p h y s i c a l health r i s k as a result o f their eating disorder. E a c h participant h a d s p o k e n to their current m e n t a l health care p r o v i d e r s p r i o r to r e s p o n d i n g to either the recruitment poster or the letters  61  o f contact that were passed o n to t h e m b y these professionals, and w e r e supported i n p a r t i c i p a t i n g i f they chose to. E a c h participant expressed a h i g h l e v e l o f e n t h u s i a s m f o r the focus o f the study and the personal, a c a d e m i c and c l i n i c a l v a l u e that it m a y offer. S e v e r a l participants reflected throughout the recruitment, i n t e r v i e w , and f o l l o w - u p v a l i d a t i o n process that their p a r t i c i p a t i o n h a d also h i g h l i g h t e d for t h e m h o w this aspect o f the eating d i s o r d e r e x p e r i e n c e h a d been neglected to this point. C r i t e r i a for giftedness were p r i m a r i l y met through m e m b e r s h i p i n gifted a n d talented h i g h s c h o o l or early entry u n i v e r s i t y p r o g r a m s , t y p i c a l l y w i t h a h i s t o r y o f several s t a n d a r d i z e d testing experiences i n d i c a t i n g giftedness. In other cases, m e e t i n g giftedness c r i t e r i a was based o n the o p i n i o n o f expert professionals, c o n s i d e r i n g also c o l l a t e r a l e v i d e n c e o f e x c e p t i o n a l a b i l i t y i n one or m o r e d o m a i n s . In a l l cases, participants possessed e v i d e n c e o f e x c e p t i o n a l a b i l i t y and achievement i n several d o m a i n s i n c l u d i n g athletic, creative, intrapersonal, a n d a c a d e m i c d o m a i n s .  Informed Consent F i v e o f the s i x participants were under the age o f 19 at the t i m e o f the i n t e r v i e w process, a n d were therefore l e g a l l y c o n s i d e r e d m i n o r s . In each o f these instances a parent/legal g u a r d i a n also p r o v i d e d consent to participate i n the study. B e c a u s e it w a s reasonable to assume that the participants themselves were capable o f u n d e r s t a n d i n g a n d m a k i n g d e c i s i o n s about their o w n p a r t i c i p a t i o n , they were also r e q u i r e d to p r o v i d e their o w n assent to participate. A s i n d i c a t e d b y the B e h a v i o u r a l R e s e a r c h E t h i c s b o a r d , assent was d e s c r i b e d as the p a r t i c i p a n t ' s agreement w i t h the d e c i s i o n o f their parent/guardian to p r o v i d e consent for p a r t i c i p a t i o n , In this w a y , l e g a l l y the participants were g i v e n consent for  62  p a r t i c i p a t i o n b y their parents, but also chose whether or not to g i v e their o w n p e r s o n a l consent for p a r t i c i p a t i o n . It w a s a s s u m e d that gifted adolescents, ages 15-18, w o u l d be competent to understand the nature and consequences o f the research and to m a k e f u l l y i n f o r m e d d e c i s i o n s r e g a r d i n g their p a r t i c i p a t i o n . T h e assent f o r m i n d i c a t e d that the m i n o r participant h a d the right to w i t h d r a w f r o m the study at any t i m e w i t h o u t consequence. Participants o v e r the age o f 19 were r e q u i r e d to p r o v i d e i n f o r m e d consent o n their o w n behalf. T h e i n d i v i d u a l s w h o served as p i l o t i n t e r v i e w participants also p r o v i d e d their f u l l y i n f o r m e d consent. T h e m a i n points addressed i n the v a r i o u s consent f o r m s were the contact i n f o r m a t i o n for student researcher a n d research supervisor, the p a r t i c i p a n t ' s right to v o l u n t a r i l y w i t h d r a w a l at any t i m e , the central purpose and procedures to be used, assurance o f the c o n f i d e n t i a l i t y o f the p a r t i c i p a n t ' s i n v o l v e m e n t and the data c o l l e c t e d , and a reference to any k n o w n r i s k s associated w i t h p a r t i c i p a t i o n . A c o p y o f the f o r m was s i g n e d p r i o r to i n v o l v e m e n t i n data c o l l e c t i o n , and the participant was g i v e n a c o p y c o n t a i n i n g contact i n f o r m a t i o n to refer to for any further i n f o r m a t i o n i f needed. It was m a d e clear f r o m the onset o f the research process that participants were free to w i t h d r a w their p a r t i c i p a t i o n at any t i m e p r i o r to the f i n a l analysis o f data w i t h o u t j u s t i f i c a t i o n or penalty.  P l e a s e see A p p e n d i c e s for  v a r i o u s consent f o r m s a n d letters o f contact a p p r o v e d b y the U B C b e h a v i o r a l ethics r e v i e w b o a r d for use i n this study.  Interview Procedures and the Phenomenological  Interview  . O p e n - e n d e d p h e n o m e n o l o g i c a l i n t e r v i e w s were i n d i v i d u a l l y c o n d u c t e d w i t h each o f the participants. A c t i v e l i s t e n i n g , empathetic reflection and m i n i m a l encouragers w e r e u s e d throughout the i n t e r v i e w to a l l o w the p h e n o m e n o n to be expressed t h r o u g h the p a r t i c i p a n t s '  63  perspective. V e r b a l p r o m p t s were used throughout the i n t e r v i e w process to facilitate the e l a b o r a t i o n o f themes brought up b y the participant, to clarify and elaborate o n the m e a n i n g a n d the e m o t i o n s related to what was v e r b a l i z e d b y the participant. F o l l o w i n g the orientating i n t r o d u c t i o n , participants were e n c o u r a g e d to t e l l the story o f their e x p e r i e n c e o f d i s o r d e r e d eating i n their o w n w o r d s and w i t h as m u c h detail as p o s s i b l e . It was suggested that a g o o d w a y to d o so m i g h t be to t h i n k b a c k to a t i m e w h e n they d i d not e x p e r i e n c e the eating disorder, and to take m e through that t i m e to the present. P a r t i c i p a n t s w e r e e n c o u r a g e d to articulate their experience i n r e l a t i o n to their e n v i r o n m e n t at h o m e , at s c h o o l , w i t h friends and f a m i l y and to elaborate o n the m e a n i n g a n d e m o t i o n s related to their experiences. Please see A p p e n d i x B for I n t e r v i e w p r o t o c o l and e x a m p l e i n t e r v i e w questions u s e d as a guide for each participant i n t e r v i e w . T h e i n t e r v i e w length was d e t e r m i n e d b y the participant and v a r i e d i n l e n g t h f r o m 1.52.5 hours. T h e i n t e r v i e w length as d e t e r m i n e d b y participant was a f u n c t i o n o f w h e n the adolescent appeared to feel that they h a d d e s c r i b e d their experience o f their eating disorder, and a l l themes w h i c h s e e m to have e m e r g e d were addressed at the l e v e l o f depth that each felt was adequate. F o l l o w i n g each i n t e r v i e w , some t i m e was spent w i t h each participant to ensure that they w e r e not e x p e r i e n c i n g p s y c h o l o g i c a l distress or d i s c o m f o r t . N o n e w a s reported, a n d w e e x p l o r e d feedback about their p a r t i c i p a t i o n i n the i n t e r v i e w . T h e t r a n s c r i p t i o n procedures and data analysis to f o l l o w was b r i e f l y d e s c r i b e d , and each participant w a s agreeable to future contact to c h e c k b a c k w i t h t h e m at points throughout the data a n a l y s i s w h e n their feedback w o u l d be o f assistance. E a c h participant expressed an interest i n k n o w i n g m o r e about the f i n d i n g s as they emerged, and seemed to express an o p i n i o n that the purpose o f this  64  study was important and m e a n i n g f u l to t h e m . L a t e r contact w i t h the participants to update t h e m o n the progress o f the study and analysis, and to validate the s u m m a r y o f their e x p e r i e n c e , c o n t i n u e d to be met w i t h e n t h u s i a s m for the study t o p i c , and f o r h o w they felt that their story was appreciated and heard throughout the i n t e r v i e w process.  Transcription  Procedures  F o l l o w i n g the participant i n t e r v i e w s , the audiotapes were subsequently t r a n s c r i b e d v e r b a t i m . G i o r g i and G i o r g i (2003) suggest that the data o f p h e n o m e n o l o g i c a l study are the "careful and accurate d e p i c t i o n s o f the o f the e v e r y d a y w o r l d events o f the participants, [and] .. .that there are n o r a t i o n a l grounds to reject t h e m " (p. 248). T h e u t i l i t y o f v e r b a t i m accounts o f the p h e n o m e n o n i n the participants' o w n w o r d s is h i g h l y regarded i n the case o f d e s c r i p t i v e p h e n o m e n o l o g i c a l procedures a c c o r d i n g to K a r l s s o n (1993), G i o r g i ( 1 9 8 5 ) , a n d G i o r g i a n d G i o r g i (2003). A s the data analysis procedures c h o s e n are based o n the a p p r o a c h taken b y K a r l s s o n , G i o r g i , and G i o r g i and G i o r g i , v e r b a t i m t r a n s c r i p t i o n o f v e r b a l a u d i o taped i n t e r v i e w s b e c a m e the raw data o f the analysis procedures. In s o m e o f the instances the student researcher c o m p l e t e d the t r a n s c r i p t i o n , a n d i n other instances a transcriptionist was used. T h e o r i g i n a l i n t e r v i e w s , o n c e transcribed, v a r i e d i n length f r o m 18-30 s i n g l e spaced pages. E v e r y audio-taped i n t e r v i e w was l i s t e n e d to several times b y the student researcher to carefully cross c h e c k for a c c u r a c y and also to b e g i n to engage i n the necessary " i m m e r s i o n " i n the data that is r e q u i r e d p r i o r to any content analysis o f the data.  65 Maintenance of  Confidentiality  A n y personal identifying information related to participants has been and w i l l be kept strictly confidential. The data were stored on floppy diskettes and computer hard drive. A u d i o recordings, transcripts and diskettes of participant interviews were stored in a locked filing cabinet. N o transcript or computer file (diskette or hard drive) contained the identification of the participant, and were identified only by a participant number and pseudonym. Signed consent forms were kept separate from the data to ensure that the anonymity of the participants is maintained. Interviews conducted were audio-taped. Only the student researcher and thesis supervisor have access to the interview recordings, transcribed data, and analysis in its entirety. Anyone with access to data was required to verbally agree to maintain confidentiality despite the fact that the recordings contained little, if any identifying information. Only the student researcher and supervising committee had access to the interview protocols in their entirety and data throughout the analysis procedures. A u d i o recordings from the interviews conducted were kept in a locked filing cabinet. Participants have not been and w i l l not be identified by name in reports or in any material, discussion or presentation relating to the project. Identifying information which may compromise the anonymity of the participants was not included as specific identifying information in the later stages of data analysis or presentation of findings. A l l participants are free to make their own decisions about disclosing their participation to whomever they choose and have a right to do so; however their identity w i l l remain confidential by the researcher. In the instances where a qualified professional assisted with the initial recruitment by passing along the recruitment information to appropriate potential  66  participants, the relationships are c o n f i d e n t i a l i n nature, and w i l l therefore also respect the a n o n y m i t y o f the i n d i v i d u a l s w h o r e c e i v e d recruitment i n f o r m a t i o n . A l t h o u g h professionals m a y g a i n k n o w l e d g e o f research p a r t i c i p a t i o n f r o m their clients, they w i l l never r e c e i v e c o n f i r m a t i o n o f p a r t i c i p a t i o n f r o m the student researcher.  Data  Analysis M c L e o d (2001) s u m m a r i z e s the a i m o f p h e n o m e n o l o g y as p r o d u c i n g an " e x h a u s t i v e  d e s c r i p t i o n " , a n d its " u l t i m a t e g o a l " as "[elucidating] the essence o f the p h e n o m e n o n b e i n g studied, as it exists i n the participants' concrete e x p e r i e n c e " (p. 4 1 ) . K a r l s s o n (1993) suggests that the ' r a i s o n d'etre' o f the E m p i r i c a l P h e n o m e n o l o g i c a l P s y c h o l o g i c a l A p p r o a c h w h i c h is a d e s c r i p t i v e p h e n o m e n o l o g i c a l m e t h o d , is to deepen o n e ' s u n d e r s t a n d i n g o f the p h e n o m e n o n b e i n g studied. T h i s is a c c o m p l i s h e d through r e v e a l i n g " e i d e t i c d i m e n s i o n s " , or the essence o f the p h e n o m e n o n (p. 88). T h e search for the essence a n d m e a n i n g structure o f the p h e n o m e n o n o f interest is also a g o a l o f the d e s c r i p t i v e p h e n o m e n o l o g i c a l a n a l y s i s o u t l i n e d b y G i o r g i (1985), G i o r g i and G i o r g i (2003), and K a r l s s o n (1993). A f t e r the i n t e r v i e w was transcribed, subsequent data analysis f o l l o w e d the d e s c r i p t i v e p h e n o m e n o l o g i c a l data analysis procedures as d e s c r i b e d b y G i o r g i (1985), G i o r g i a n d G i o r g i (2003) a n d K a r l s s o n (1993). T h e E m p i r i c a l P h e n o m e n o l o g i c a l P s y c h o l o g i c a l A p p r o a c h ( E P P - m e t h o d ) o u t l i n e d b y K a r l s s o n , and T h e D e s c r i p t i v e P h e n o m e n o l o g i c a l P s y c h o l o g i c a l A p p r o a c h o u t l i n e d b y G i o r g i and G i o r g i , p r o v i d e d the basis for data a n a l y s i s . T h e researcher's understanding and f a m i l i a r i t y w i t h various aspects o f d e s c r i p t i v e p h e n o m e n o l o g y were supplemented through t h o r o u g h e x p l o r a t i o n o f m a n y o f G i o r g i ' s o r i g i n a l w r i t i n g (i.e., G i o r g i , 1985, G i o r g i , 1997).  67  T h r o u g h o u t the analysis and data c o l l e c t i o n a p h e n o m e n o l o g i c a l attitude a n d " p a r t i a l p h e n o m e n o n o l o g i c a l r e d u c t i o n " were adhered to. T h r o u g h this stance, w h i c h i n v o l v e s " b r a c k e t i n g a l l theories, hypotheses, m o d e l s and systems w h i c h are o t h e r w i s e u s e d i n order to e x p l a i n the p h e n o m e n o n i n q u e s t i o n " ( K a r l s s o n , 1993, p . 81), the m e a n i n g structure o f the e x p e r i e n c e o f an eating disorder for the participants was e x p l o r e d . A s per the o u t l i n e d procedures for p h e n o m e n o l o g i c a l analysis referred to b y G i o r g i and G i o r g i (2003) and K a r l s s o n (1993), data analysis procedures were as f o l l o w s . It w a s noted that the strength o f the analysis as a w h o l e rests o n each o f the i n d i v i d u a l steps, a n d that each o f these steps b u i l d s o n the last. T h e data analysis procedures f o l l o w ; l i s t e d i n n u m b e r p o i n t s are those i n d i c a t e d and d e s c r i b e d b y the s a i d theorists. T h e n u m e r i c a l subpoints are i d i o s y n c r a t i c w a y s i n w h i c h the data analysis procedures were i m p l e m e n t e d a n d further b r o k e n d o w n b y the student researcher i n order to manage the data f o l l o w i n g the t r a n s c r i p t i o n process. T h r o u g h o u t these steps, b r a c k e t i n g o f the researcher's biases was a p p l i e d , reflected o n , and m o n i t o r e d i n the reflective j o u r n a l . 1.  R e a d i n g o f the transcript for a grasp or sense o f the w h o l e and i m m e r s i o n i n the text. a)  T r a n s c r i p t s were read t h r o u g h several times for a sense o f the parts a n d h o w they related to the totality o f the experience articulated t h r o u g h the i n t e r v i e w .  b)  A u d i o taped i n t e r v i e w s were listened to several times to verify a c c u r a c y w i t h the transcripts and to also engage i n i m m e r s i o n i n the data and the e x p e r i e n c e o f the eating disorder for the participants.  2.  M e a n i n g units ( M U s ) were established and represented a b r e a k i n g d o w n o f the transcripts into s m a l l e r units. M e a n i n g units were defined as subjective shift i n m e a n i n g d i s c e r n e d w h e n the researcher denotes a shift i n m e a n i n g . G i o r g i a n d G i o r g i  68  (2003) suggest that m e a n i n g units are not r e q u i r e d to be i d e n t i c a l b e t w e e n researchers, and are not " t h e o r e t i c a l l y w e i g h t y " or " o b j e c t i v e " , and are m o r e o f p r a c t i c a l a i d i n m a n a g i n g the analysis (p. 2 5 2 ) . a)  M e a n i n g units were delineated w h e n a shift i n m e a n i n g was i n t u i t e d a n d w h e n it seemed as t h o u g h the content o f each unit h a d one m e a n i n g , e v e n i f it c o u l d be interpreted i n m o r e than one w a y .  b)  E a c h transcript was b r o k e n d o w n into between 3 2 0 a n d 4 8 0 m e a n i n g units, each was noted w i t h a slash m a r k (/) i n the transcript.  c)  A t this stage the thesis supervisor assisted i n v e r i f y i n g samples o f d e l i n e a t e d m e a n i n g units a m o n g several transcripts, t y p i c a l l y w i t h v e r y h i g h agreement.  d)  T h e m e a n i n g units delineated i n the transcripts were t r a n s f o r m e d i n t o tables i n w h i c h the 1 c o l u m n represented the participant n u m b e r , the 2 st  represented the M U number, and the 3  r d  n d  column  c o l u m n represented the text o f the  MU. e)  L a t e r i n the analysis, i f a m e a n i n g unit appeared to require further b r e a k i n g d o w n , this was done at that stage.  G i o r g i and G i o r g i (2003) describe the 3  r d  stage as "transformation o f the m e a n i n g  units into p s y c h o l o g i c a l l y sensitive e x p r e s s i o n s " (p. 2 5 2 ) . It is suggested that at this stage the p s y c h o l o g i c a l relevance o f the m e a n i n g units as they relate to the p h e n o m e n o n are d e v e l o p e d . It is c a u t i o n e d to a v o i d the errors o f u s i n g p s y c h o l o g i c a l j a r g o n at this stage and to not take the relevance o f the p e r s o n a l l i v e s o f the participant b e y o n d the p s y c h o l o g i c a l experience o f the p h e n o m e n o n .  Karlsson  (1993) refers to this stage as the "eidetic i n d u c t i o n through interpretation". It is at  69  this stage w h e r e the m e a n i n g s o f the p h e n o m e n o n and M U s as articulated b y the participants are elaborated o n and g i v e n p s y c h o l o g i c a l m e a n i n g . K a r l s s o n (1993) specifies t w o " m o d e s o f u n d e r s t a n d i n g " to engage i n this process, 1) the "researcher's empathetic u n d e r s t a n d i n g " ( R E U ) , and 2) the "researcher's interpretive u n d e r s t a n d i n g " ( R I U ) (p. 86-87). T h e R E U is v i e w e d m o r e as an u n d e r s t a n d i n g o f the e x p e r i e n c e o f the participant at a " c o m m o n sense" and "straight f o r w a r d " l e v e l , and the R I U " b r i n g s forth the m e a n i n g structure" o f the e x p e r i e n c e a n d contributes to u n d e r s t a n d i n g the u n d e r l y i n g essence and m e a n i n g o f the p h e n o m e n o n (p. 87). K a r l s s o n suggests that the R E U is subordinate to the R I U , and that it is the interpretative understanding o f the researcher that is m o r e important, yet m o v e m e n t between the t w o w a y s o f understanding are c r i t i c a l to this stage o f the a n a l y s i s . K a r l s s o n also cautions that "theory-laden l a n g u a g e " be a v o i d e d at this stage (p. 98). a)  The 4  t h  c o l u m n o f the table used for data analysis represented w h e r e this stage  o f the analysis took place. b)  T h e content o f the m e a n i n g units were " c o d e d " b a s e d o n the p r i n c i p l e s o f g i v i n g p s y c h o l o g i c a l m e a n i n g , empathetic and interpretive u n d e r s t a n d i n g as o u t l i n e d above.  c)  T h e p r i m a r y p s y c h o l o g i c a l m e a n i n g as it related to the p h e n o m e n o n was noted first (for e x a m p l e : P e r f e c t i o n i s m , A p p r e c i a t i o n and R e c o g n i t i o n o f V a l u e , P u r p o s e , etc.) and then was further elaborated o n w i t h details o f the particular code. T h i s step a l l o w e d for ease i n sorting the M U s and codes u s i n g c o m p u t e r - a i d e d sorting o f tables.  70  d)  A t this stage m y thesis supervisor assisted i n c o d i n g w h e n d i s c e r n i n g the p s y c h o l o g i c a l m e a n i n g o f the M U s p o s e d d i f f i c u l t y , and v a l i d a t e d samples o f c o d e d M U s f r o m several participant tables.  e)  T h e c o d e d M U s were sorted for each participant i n i n d i v i d u a l tables.  f)  T h e c o d e d m e a n i n g units were c o m b i n e d into one table and also sorted i n that format (table i n excess o f 160 pages). T h e four c o l u m n s u s e d e n a b l e d d e c i p h e r i n g o f the codes or themes that were core and c o m m o n a m o n g the participants.  G i o r g i a n d G i o r g i (2003) note this step as the last, and d o not m a k e e x p l i c i t the f i n a l stage o u t l i n e d b y K a r l s s o n (1993). G i o r g i and G i o r g i identify this stage as the " d e t e r m i n a t i o n o f structure", and where one identifies what is t r u l y essential a n d the m o s t " i n v a r i a n t c o n n e c t e d meanings b e l o n g i n g to the e x p e r i e n c e " , r e s u l t i n g i n d e s c r i p t i o n o f the p s y c h o l o g i c a l structure o f the p h e n o m e n o n (p. 2 5 3 ) . K a r l s s o n (1993) refers to the fourth stage as representing the "situated structure" or s y n o p s i s o f the p a r t i c i p a n t s ' experience o f the p h e n o m e n o n . a)  E a c h participant table, w h i c h h a d been c o d e d and sorted to r e v e a l the c o r e and essential themes o f each experience o f the p h e n o m e n o n , f o r m e d the basis for the situated structures d e v e l o p e d for each participant.  b)  T h e core themes f r o m each participant were o v e r w h e l m i n g to o r g a n i z e b a s e d o n the length o f the tables. T o p r o v i d e ease i n o r g a n i z i n g and d e v e l o p i n g a coherent account o f their experience, core themes were represented i n a v i s u a l concept or theme m a p , w h i c h g u i d e d the w a y i n w h i c h each p a r t i c i p a n t ' s story w o u l d be d e v e l o p e d .  c)  C a r e was taken to incorporate a l l aspects o f the p h e n o m e n o n , as they w e r e presented b y the participant, i n a short length format.  d)  A t this stage, the thesis s u p e r v i s o r proofread and p r o v i d e d feedback o n e a c h situated structure d e v e l o p e d .  e)  E a c h participant was g i v e n a c o p y o f their situated structure and a s k e d to p r o v i d e feedback. T h e y were requested to r e s p o n d to whether the s u m m a r y fit or resonated w i t h the experience o f the p h e n o m e n o n as they d e s c r i b e d it i n the i n t e r v i e w , and i f any significant themes were left out.  T h e f i n a l stage is the d e v e l o p m e n t o f a general structure based o n the core a n d c o m m o n themes o f a l l participants.  K a r l s s o n (1993) defines the f i n a l step o f the  analysis to i n c l u d e ( i f p o s s i b l e ) the general structure a m o n g m a n y e x a m p l e s o f the p h e n o m e n o n . K a r l s s o n suggests "It is i m p o s s i b l e i n advance to m a k e a general statement about e x a c t l y u p o n w h i c h l e v e l o f abstractness the results w i l l be expressed. It is u p to each researcher to determine h o w far the analysis w i l l g o " (p. 80).  I f p o s s i b l e , analysis s h o u l d p r o c e e d to t y p o l o g i c a l or general structures w h i l e  k e e p i n g i n m i n d that the "interesting p s y c h o l o g i c a l d i s c o v e r i e s " s h o u l d not be o v e r l o o k e d and to c o n s i d e r the l e v e l o f abstraction that is o f v a l u e to the researcher (p. 108). a)  A general structure, or the core and c o m m o n themes o f the e x p e r i e n c e o f an eating disorder a m o n g the sample was d e v e l o p e d based o n the f i n a l themes i n the sorted table, i n c l u d i n g a l l participants' account o f the e x p e r i e n c e .  72 b) The themes for each of the participants were sorted through, and the common themes outlined and described based on several methods of organizing the data (for example: based on participant quotes, common themes, reorganized when a sub-theme was contained in coded meaning unit, etc.). c) Each theme was justified based on reference back to the original transcripts and individual sorted tables. d) The common themes were sorted and organized into main and sub-themes. e) Each theme and sub-theme was described, and then elaborated on and validated through thick description and participant quotes.  Presentation of Findings At the onset of the data analysis process, it was unclear how the data may be represented in their final form. Karlsson (1993) suggests that a general structure may be the end result of the data analysis "when all protocols can be meaningfully condensed into one single structure" (p. 88). Karlsson also suggests that a study should consider "typological structures", which is preferable when "more than one structure of the phenomenon" is contained in the data, due to the risk of loss of psychological meaning should the data be forced into a general structure (Karlsson, 1993, p. 88). Karlsson suggests that results according to the EPP-method may contain "both general and typological constituents" (p. 88). A situated structure was developed for each participant, and the possibility of either a general or typological structure was seen as a realistic possibility for the final data analysis and presentation of findings. Upon completion of the data analysis, which involved Over 160  73  pages o f c o d e d data i n table format, c o r e a n d c o m m o n themes for a l l participants w e r e d e v e l o p e d . T h e general structure, o r core a n d c o m m o n themes represents "general constituents" as d e s c r i b e d b y K a r l s s o n (1993) o f the experience o f an eating disorder, w h i l e the situated structures presented i n the f i n d i n g s are less abstract a n d speak m o r e to the subjective e x p e r i e n c e o f each u n i q u e participants' l i v e d experience o f their eating disorder.  Ethical  Considerations T h e p r o t o c o l a n d nature o f this study r e c e i v e d f u l l e t h i c a l a p p r o v a l f r o m the  B e h a v i o u r a l E t h i c s R e v i e w B o a r d o f the U n i v e r s i t y o f B r i t i s h C o l u m b i a . S t r i c t e t h i c a l standards w e r e m a i n t a i n e d throughout the recruitment, i n t e r v i e w , t r a n s c r i p t i o n a n d data a n a l y s i s processes. S u b s e q u e n t l y the study w a s granted r e n e w a l a n d a m e n d m e n t to a l l o w for future use o f the data a n d contact w i t h participants. T h e l i m i t s o f c o n f i d e n t i a l i t y were agreed to a n d w e r e u n d e r s t o o d b y the p a r t i c i p a n t at the onset o f the i n t e r v i e w process. T h i s w a s essential to ensure the p s y c h o l o g i c a l a n d p h y s i c a l safety that m a y relate to r e c o u n t i n g a p h e n o m e n o n such as this. A n y d i s c l o s u r e o f a p a r t i c i p a n t ' s intent to h a r m themselves or another person, or reported i n c i d e n t s o f c h i l d abuse w o u l d have been reported to the proper authorities. A l l participants w e r e r e c e i v i n g o r h a v e r e c e i v e d eating d i s o r d e r c o u n s e l l i n g or treatment for d i s o r d e r e d eating. A l l participants i n d i c a t e d that they h a d easy access to support f r o m their present or past eating d i s o r d e r treatment p r o v i d e r s . T h i s p r o v i d e d s o m e assurance that the p a r t i c i p a n t s ' p s y c h o l o g i c a l w e l l b e i n g is addressed m o r e t h o r o u g h l y a n d o n an o n - g o i n g basis i f necessary b y other q u a l i f i e d professionals.  F o l l o w i n g the i n t e r v i e w process, I spent t i m e w i t h each p a r t i c i p a n t to d e b r i e f  any f e e l i n g o f p s y c h o l o g i c a l stress o r upset that they m a y be f e e l i n g . N o p a r t i c i p a n t  74  i n d i c a t e d v e r b a l l y or t h r o u g h m y o b s e r v a t i o n to be p s y c h o l o g i c a l l y unsafe or v u l n e r a b l e f o l l o w i n g the i n t e r v i e w process. M o s t participants expressed an e n t h u s i a s m f o r h a v i n g engaged i n the i n t e r v i e w process and several m e n t i o n e d that they l o o k e d f o r w a r d to t a l k i n g about the v a l u e and experience o f the i n t e r v i e w w i t h their personal therapist. A l t h o u g h I w o r k i n the eating disorders f i e l d as a therapist and d i d have direct access to several potential participants through that role, i n no instance d i d I engage i n a d u a l r e l a t i o n s h i p w i t h a participant, i n w h i c h I f u n c t i o n e d as the p a r t i c i p a n t ' s therapist. I chose to a v o i d r e c r u i t i n g any clients w h o receive services through the p r o g r a m w h e r e I a m e m p l o y e d to a v o i d p o s s i b l e e t h i c a l considerations, d i s c o m f o r t , or d u a l relationships i n the future.  Delimitations T h i s study intended to p r o v i d e an in-depth d e s c r i p t i o n o f the e x p e r i e n c e o f an eating d i s o r d e r a m o n g gifted f e m a l e adolescents. P r i o r to b e g i n n i n g the study several d e l i m i t a t i o n s were noted based o n the selection o f a qualitative research p a r a d i g m , the a c c o m p a n y i n g m e t h o d o l o g y , p a r t i c i p a n t s ' factors, and the operational definitions that were u t i l i z e d . T h e results o f this study cannot be c o n s i d e r e d c o m p a r a b l e to the e x p e r i e n c e o f d i s o r d e r e d eating a m o n g other specific s a m p l e p o p u l a t i o n s . A q u a l i t a t i v e d e s c r i p t i o n o f the e x p e r i e n c e o f an eating d i s o r d e r a m o n g a non-gifted p o p u l a t i o n is not, to m y k n o w l e d g e , c u r r e n t l y a v a i l a b l e so it is not clear h o w the results o f this study relate to other p o p u l a t i o n s . T h e narrative d e s c r i p t i o n o f the core and c o m m o n themes o f the l i v e d e x p e r i e n c e o f d i s o r d e r e d eating, therefore, m a y or m a y not reflect the experience o f " n o n - g i f t e d " adolescents. T h e issue o f whether gifted adolescents actually e x p e r i e n c e an eating d i s o r d e r i n a u n i q u e w a y , or whether it is o n l y the w a y i n w h i c h they articulate their e x p e r i e n c e that is  75  u n i q u e is a s i g n i f i c a n t c o n s i d e r a t i o n . G i v e n the nature o f the c h o s e n m e t h o d the s a m p l e s i z e was s m a l l (6-10 participants) w h i c h has i m p l i c a t i o n s for the g e n e r a l i z a b i l i t y o f the f i n d i n g s . T h e d e f i n i t i o n o f giftedness i n current literature is i n c o n s i s t e n t l y and p o o r l y d e f i n e d , and the o p e r a t i o n a l d e f i n i t i o n o f giftedness i n this study m a y not agree w i t h that u s e d i n other p u b l i c a t i o n s . W h e t h e r or not the gifted p o p u l a t i o n i n this study matches the gifted p o p u l a t i o n o f other studies is relevant but this d e l i m i t a t i o n is i n e v i t a b l e g i v e n the l a c k o f a u n i v e r s a l o p e r a t i o n a l d e f i n i t i o n for giftedness. T h e i d e n t i f i c a t i o n o f gifted adolescents t h r o u g h p a r t i c i p a t i o n i n gifted and talented e d u c a t i o n a l p r o g r a m s or b y c o n s i d e r i n g a d v a n c e d c o g n i t i v e d e v e l o p m e n t m a y have e x c l u d e d several potential participants f r o m the s a m p l e . D u a l relationships w i t h participants were a v o i d e d (i.e., c o u n s e l l o r and researcher). G i v e n the secretive nature o f disordered eating, the participants' age, and the p a r t i c u l a r reluctance o f gifted adolescents to share their experiences w i t h those they d o not k n o w , n o t e d b y J a c k s o n a n d P e r s o n (2003), it is questionable whether sufficient rapport c o u l d be established for participants to share their experiences o p e n l y .  Diversity Issues T h e focus o f this study was o n female participants w h o have i n the past f i v e years e x p e r i e n c e d , or w h o c u r r e n t l y experience d i s o r d e r e d eating as adolescents (age 15-18). I n v e s t i g a t i o n o f a female adolescent p o p u l a t i o n was c h o s e n based o n the h i g h e r p r e v a l e n c e o f d i s o r d e r e d eating a m o n g females than males ( A P A , 2 0 0 0 ) . T h e e x p e r i e n c e o f d i s o r d e r e d eating a m o n g m a l e or adult p o p u l a t i o n s m a y differ, and for that reason the target s a m p l e is l i m i t e d i n that respect. A d o l e s c e n t s y o u n g e r than 15 years o f age h a v e also been e x c l u d e d , as their e x p e r i e n c e m a y also differ or be articulated differently than that o f o l d e r adolescents.  76 P a r t i c i p a n t s were r e q u i r e d to speak E n g l i s h , as it is the p r i m a r y language o f the student researcher.  Interviews, transcription, data analysis and the written thesis project w i l l be  c o m m u n i c a t e d i n E n g l i s h . N o n - g i f t e d adolescents as defined b y the s e l e c t i o n c r i t e r i a a n d operational definitions chosen p r i o r to c o n d u c t i n g the study were not i n c l u d e d i n the s a m p l e . T h i s e x c l u s i o n was not based o n any d i s c r i m i n a t o r y bias, but instead to n a r r o w the focus o f the s a m p l e , subsequent analysis and results to a target p o p u l a t i o n .  Validity and  Reliability  M a x w e l l (1992) c o m m e n t s o n the frequent challenges to the v a l i d i t y o f q u a l i t a t i v e research and f i n d i n g s . D e s p i t e the challenges o f e s t a b l i s h i n g v a l i d i t y and c o n s i d e r i n g v a r i o u s approaches a n d methods to do so, it is agreed that qualitative studies m u s t demonstrate c r e d i b i l i t y ( C r e s w e l l & M i l l e r , 2 0 0 0 ) . M a x w e l l (1992) refers to several forms o f c r e d i b i l i t y / v a l i d i t y that s h o u l d be c o n s i d e r e d i n qualitative research. T h e t w o forms o f v a l i d i t y that are o f p a r t i c u l a r relevance to this study i n c l u d e d e s c r i p t i v e and interpretative v a l i d i t y . D e s c r i p t i v e v a l i d i t y refers to the "factual a c c u r a c y o f their [the researcher's] account - t h a t is that they are not m a k i n g u p or distorting the things they saw or h e a r d " (p. 285). Interpretive v a l i d i t y refers to the descriptions a n d m e a n i n g interpreted f r o m the participants' perspective. In this study, the standards o f d e s c r i p t i v e v a l i d i t y d e s c r i b e d were met through a u d i o t a p i n g o f the i n t e r v i e w s and careful v e r i f i c a t i o n o f transcripts. Standards o f interpretive v a l i d i t y w e r e met t h r o u g h v e r i f i c a t i o n o f analysis at each stage w i t h m y thesis supervisor, and through feedback f r o m participants, w h i c h c o n f i r m e d that the d e s c r i p t i o n and m e a n i n g o f their e x p e r i e n c e interpreted b y the researcher resonated w i t h them.  77  In an attempt to c l a r i f y and o r g a n i z e some o f the methods for e s t a b l i s h i n g v a l i d i t y i n q u a l i t a t i v e research, and to a i d i n their c h o i c e and use, C r e s w e l l and M i l l e r (2000) p r o v i d e a f r a m e w o r k t h r o u g h w h i c h v a l i d i t y m a y be considered. It is suggested that d e p e n d i n g o n the lens t h r o u g h w h i c h the researcher v i e w s the study, certain v a l i d i t y procedures s h o u l d be c o n s i d e r e d . It is suggested that one lens through w h i c h v a l i d i t y s h o u l d be c o n s i d e r e d is that o f the researcher, another is that o f the participants i n the study, and the last is a c r i t i c a l lens. D e p e n d i n g o n the lens used, specific v a l i d i t y procedures m a y i n c l u d e : 1) t r i a n g u l a t i o n o f data, 2) use o f d i s c o n f i r m i n g e v i d e n c e , 3) researcher r e f l e x i v i t y and d i s c l o s u r e o f biases, assumptions and beliefs, 4) m e m b e r c h e c k i n g - t a k i n g data and narratives d e v e l o p e d b a c k to the participants, 5) p r o l o n g e d engagement i n the f i e l d , 6) c o l l a b o r a t i o n throughout the research process w i t h participants, 7) an audit trail to e x a m i n e both the process t h r o u g h w h i c h the results e m e r g e d and the f i n a l results, 8) t h i c k , r i c h d e s c r i p t i o n o f the participants, setting a n d results so that the reader m a y generalize f i n d i n g s , and 9) peer r e v i e w or d e b r i e f i n g -where s o m e o n e f a m i l i a r w i t h the p h e n o m e n o n r e v i e w s that data, a n a l y s i s , a n d results. M c G r a t h and J o h n s o n (2003) discuss issues related to e s t a b l i s h i n g c r e d i b i l i t y ( v a l i d i t y or truth) and trustworthiness i n qualitative research. L i n c o l n and G u b a (1985) suggest that trustworthiness is the central and most c r i t i c a l standard to w h i c h any study s h o u l d be h e l d (as c i t e d i n M c G r a t h & J o h n s o n ) . C r e s w e l l (1998) also refers to the w o r k o f L i n c o l n a n d G u b a a n d articulates h o w terms u s e d i n assessing the q u a l i t y a n d v e r i f i c a t i o n o f qualitative w o r k i n c l u d e the study's c r e d i b i l i t y , transferability, d e p e n d a b i l i t y and c o n f i r m a b i l i t y . Internal v a l i d i t y refers to the c r e d i b i l i t y or truth o f the f i n d i n g s i n q u a l i t a t i v e w o r k , external v a l i d i t y refers to transferability or whether f i n d i n g s transfer f r o m researcher to  78  those b e i n g studied, r e l i a b i l i t y a n d o b j e c t i v i t y refer to whether the q u a l i t a t i v e results are dependable a n d c o n f i r m a b l e through a u d i t i n g and b r a c k e t i n g o f the researcher's biases. P r o c e d u r e s for e s t a b l i s h i n g trustworthiness, c r e d i b i l i t y a n d v e r i f i c a t i o n u s e d i n this study i n c l u d e : 1) stating and r e f l e c t i n g o n biases, assumptions a n d beliefs related to the p h e n o m e n o n o f interest throughout the research process, use o f f i e l d notes, a n d a r e f l e c t i v e j o u r n a l , 2) m e m b e r c h e c k i n g , as the lens o f the participants was seen as the m o s t r i g o r o u s f o r m o f v a l i d i t y v e r i f i c a t i o n , 3) an audit trail, i n w h i c h a l l research a n d data analysis procedures w e r e o u t l i n e d i n detailed a n d m o n i t o r e d b y the thesis s u p e r v i s o r , 4) t h i c k a n d r i c h d e s c r i p t i o n o f the f i n d i n g s , substantiated b y direct quotes, so the reader m a y c o m e to their o w n c o n c l u s i o n s about the transferability o f the f i n d i n g s .  79  CHAPTER IV Results T e n m a i n codes e m e r g e d through the analysis o f data. T h e s e themes represent the general structure, core and c o m m o n themes o f the experience o f an eating d i s o r d e r a m o n g the gifted female adolescent participants. T h e s e themes i n c l u d e : 1) N e g a t i v e A f f e c t a n d S e l f P e r c e p t i o n s , E m o t i o n a l P a i n , and D e t e r i o r a t i o n , 2) O v e r w h e l m e d and C o n f l i c t e d , 3) N o t F i t t i n g : I n c o n g r u e n c e and A w a r e n e s s o f D i f f e r e n c e s , 4) C o p i n g T h r o u g h E n g a g i n g i n the E a t i n g D i s o r d e r , 5) E x p e r i e n c e o f Giftedness and E a t i n g D i s o r d e r and/or S t r u g g l e E x p l i c i t l y C o n n e c t e d , 6) P e r f e c t i o n i s m - S t r i v i n g to A t t a i n "Perfect", 7) C o n t r o l and R e s t r i c t i o n , 8) A w a r e n e s s o f M u l t i f a c e t e d U n d e r l y i n g F a c t o r s , 9) S a c r i f i c e , D e f i a n c e and Separation: O f Self, o f B o d y , and o f N e e d s , 10) A p p r e c i a t e d , P u r p o s e f u l and M e a n i n g f u l E x p e r i e n c e . S e v e r a l o f these themes also c o n t a i n sub-themes, w h i c h further elaborate o n and p r o v i d e depth to the themes that they are s u b s u m e d b y . A l l o f the m a i n themes represent the i n v a r i a n t structure or essence o f the experience o f an eating disorder for each o f the participants. E a c h sub-theme applies to the experience o f A n o r e x i a for a l l or the m a j o r i t y o f the participants. T h e sub-themes are u n d e r l i n e d throughout the presentation o f the results. Presentation o f the f i n d i n g s i n this chapter i n c l u d e s a situated structure for each participant, w h i c h details the essence o f their p e r s o n a l eating disorder experience, f o l l o w e d b y a table that outlines the m a i n themes and sub-themes o f the general structures a m o n g the participants. T h e themes and sub-themes are further elaborated o n t h r o u g h r i c h d e s c r i p t i o n and excerpts f r o m the participant i n t e r v i e w s , w h i c h validate the themes a n d p r o v i d e e x a m p l e s o f their substance t h r o u g h the "lens o f the participant".  80 Situated Structures Esprit There is a connection between my sensitivity and kind of being more of like a sponge, in between that and being more prone I guess to having problems.  Esprit's struggle with Anorexia is one in which she searches for the meaning and purpose of its presence in her life. She experiences feelings of self-blame and guilt for allowing Anorexia into her life when she should "know better". A sense of frustration with the non-rational and complex nature of eating disorders and a continuous struggle is present in her experience. Conflict and incongruence within herself arise and comprise the "root of her struggle", as she considers the meaning of thinness and the contradiction between her focus on physical attributes while valuing more fully "beauty of character". What began as a means to fit in, to seek control when other areas of her life felt out of control, and a way to "be healthy", led to restriction of her intake, rapid weight loss and physical deterioration which resulted in her being medically compromised and hospitalized. She describes her eating disorder as having a voice as she attempts to externalize Anorexia from her sense of self. The voice of the eating disorder is critical of her, and has destructive and negative intentions for Esprit. Esprit experiences fear and emotional pain as she considers whether she w i l l be able to let go of her eating disorder. She explicitly connects giftedness with perfectionism, psychological and existential struggle, and her personal experience with Anorexia and Depression. She challenges whether the qualities that she appreciates as being part of giftedness w i l l "always go hand in hand" with Anorexia, and whether she can maintain those  81 qualities yet recover. S h e questions whether an i n e v i t a b l e struggle w i l l exist f o r those w h o , l i k e her, e x p e r i e n c e the w o r l d i n a different w a y .  Is it the perfectionism and perseverance, sensitivity and awareness of the world that enables you do well at school and open to the rest of the world and see there are so many things that need changing and yes it is overwhelming but finding something that I can do, starting projects or being active and it's great. That's my life that's what I want to do always but at the same time it is the same kind of things that keep Anorexia going in me and adds fuel to the fire... perfectionism and destructive behaviour. F r u s t r a t i o n a n d c o n f l i c t arise w i t h i n her as she experiences guilt related to e x p e r i e n c i n g her o w n struggle w h i l e she is m i n d f u l o f the suffering o f others. S h e i n d i c a t e s that t h r o u g h her eating disorder she is c o p i n g w i t h the " P a i n o f E x i s t e n c e " , w h i c h she describes as:  The pain of finding your place in the world and the universe.  Trying to go beyond  yourself, trying to make sense of things, not understanding things, why things happen, unfairness.  The conflict between our best intentions and what actually goes on in  everyday life H e r r e a c t i o n to the w o r l d a n d to the " P a i n o f E x i s t e n c e " is o v e r w h e l m i n g to her, a n d leads her to f e e l i n g trapped b y qualities w i t h i n herself w h i c h she seems to c h e r i s h , but also sees as the basis f o r her self-destruction. A n o r e x i a a l l o w s her to c o p e b y i n t e r n a l i z i n g the p a i n that she feels f r o m the e n v i r o n m e n t a n d i n r e a c t i o n to the w o r l d . S h e experiences c o n f l i c t i n g d y n a m i c s w i t h i n herself w h e n she a c k n o w l e d g e s that the p o w e r a n d m e a n i n g o f p h y s i c a l ideals a n d thinness, ideals she considers " s h a l l o w " , are part o f her struggle a n d are  82 i n c o n g r u e n t w i t h the depth o f her experiences, feelings and values. S h e continues to h o l d o n to the n o t i o n that thinness m a y b r i n g her happiness and a l l o w her to " f i t i n " , a l t h o u g h she is c o g n i t i v e l y aware that is not the case. A n o r e x i a has been a w a y for E s p r i t to c o p e w i t h m a n y o f the c h a l l e n g e s a n d i n c o n g r u o u s elements i n her e n v i r o n m e n t . S h e is aware o f her differences f r o m her peers a n d o f the i s o l a t i o n and separateness she feels e v e n w i t h i n her o w n f a m i l y . P e r c e i v i n g h e r s e l f as " c h u b b y " as a c h i l d , f e e l i n g different f r o m her peers, and not fitting i n d e v e l o p m e n t a l l y , are a l l c o n n e c t e d to her search for happiness through a p h y s i c a l i d e a l . F i t t i n g i n p h y s i c a l l y appears to h a v e been an attempt to deal w i t h " p a i n and sadness", and to fit i n , i n a m o r e general sense. T h e apparent s o l u t i o n that A n o r e x i a p r o m i s e d does not appear to have been a c h i e v e d as she w o r k s t o w a r d accepting her awareness o f her differences. E s p r i t describes heightened sensitivities to the "subtleties" i n her e n v i r o n m e n t a n d to the expectations, needs a n d feelings o f others. S h e relates her " s e n s i t i v i t y " to w h y the eating d i s o r d e r t o o k h o l d o f her life and c o n t r o l l e d her. T h r o u g h o u t her e x p e r i e n c e she identifies b e i n g c o n t r o l l e d b y her eating disorder and b y those around her. T h e i r o n y o f the means t h r o u g h w h i c h she sought c o n t r o l then t a k i n g c o n t r o l o f her and her life is present i n her consciousness. E s p r i t sees a n e e d for personal c o n t r o l , and defiance o f her parents' expectations a n d their p e r c e i v e d c o n t r o l o f her, as a basis for her need to use restriction o f her intake as a means to c o p e and as a s o l u t i o n . S h e indicates that she gains a sense o f p o w e r a n d satisfaction f r o m d e f y i n g her p h y s i o l o g i c a l needs. A s a " g o o d g i r l " , she appears to feel that she f o u n d a w a y to i n t e r n a l i z e her p a i n rather than externalize it or to defy her parents i n " t y p i c a l " adolescent f a s h i o n .  0  83 E s p r i t strives to l i v e up to h i g h self-expectations c h a r a c t e r i z e d b y p e r f e c t i o n i s m w h i l e she attempts to satisfy her o w n " i m a g e o f h e r s e l f . H e r p e r f e c t i o n i s m extends into her h u m a n i t a r i a n endeavors and desire to care for others, w h i c h she sees as " p e r f e c t i o n towards others". H e r e x p e r i e n c e w i t h i n her o w n f a m i l y through her e x p e r i e n c e o f A n o r e x i a is one i n w h i c h she has felt that she has been i d e n t i f i e d as the p r o b l e m . S h e tries to see A n o r e x i a or m a l f u n c t i o n as s o m e t h i n g that exists i n her w h o l e f a m i l y and that she is m e r e l y the m e m b e r that " e m b o d i e s i t " . S h e has i n t e r n a l i z e d c r i t i c i s m , feelings o f g u i l t and b l a m e that she p e r c e i v e s as e x i s t i n g i n her f a m i l y ' s reaction t o w a r d her. E s p r i t continues to m a i n t a i n hope that she w i l l be free o f A n o r e x i a , and i f she is u n a b l e to r e c o v e r f o r h e r s e l f then she m a y be m o t i v a t e d to r e c o v e r for others. A s she searches for h o w to m a k e sense o f and f i n d m e a n i n g i n her experience, she reflects o n her a p p r e c i a t i o n o f the value o f the eating disorder i n her life. S h e feels that t h r o u g h her struggle she has b e c o m e m o r e compassionate, g a i n e d strength, and g r o w n . A n o r e x i a is not an e x p e r i e n c e that she is sure she w o u l d trade i f g i v e n the opportunity.  "it definitely makes you a stronger person in the end if you get to the end."  Andrea I was starving myself to the point of death, but not for the purpose to be skinny, but for the purpose of being erased  A n d r e a ' s struggle w i t h A n o r e x i a is one o f searching, purpose, a n d separation o f m i n d and b o d y . It is also a means through w h i c h to c o p e w i t h elements i n her e x p e r i e n c e that  84  o v e r w h e l m e d her and that she b e c a m e trapped b y . A n o r e x i a was a w a y for her to separate a n d dissociate herself f r o m her b o d y , f r o m her p h y s i c a l and e m o t i o n a l needs, her r e a c t i o n to the w o r l d , her sacrifice o f her o w n needs for those o f others, as w e l l as peer and f a m i l y e n v i r o n m e n t s w h i c h d i d not fit for her. A n d r e a is unable to r e m e m b e r a t i m e w h e n eating was "not a b i g d e a l " for her.  She  recalls b o d y p r e o c c u p a t i o n amongst her earliest m e m o r i e s . She sees her b o d y as m o r e o f a v e h i c l e t h r o u g h w h i c h to a c c o m p l i s h things than as part o f herself. "I've a l w a y s l i k e g i v e n l i k e a pedestal t o . . . the i d e a o f s a c r i f i c e " . S a c r i f i c e o f her b o d y for a c h i e v e m e n t o f goals and sacrifice as a requisite for success relates to her experience w i t h starvation and A n o r e x i a . A n o r e x i a was not about p h y s i c a l ideals or thinness but was about b e i n g "successful at s o m e t h i n g " , "at a l l costs". S a c r i f i c e g i v e s m e a n i n g to her experience o f A n o r e x i a . W h a t began as an attempt to be " h e a l t h y " and active l e d to severe r e s t r i c t i o n o f her intake, s i g n i f i c a n t w e i g h t loss and h o s p i t a l i z a t i o n . A n d r e a ' s experience i n c l u d e s awareness that "despite it a l l b e i n g about eating and not eating, it has n o t h i n g to d o w i t h i t " . W h i l e she was m e d i c a l l y c o m p r o m i s e d she e x p e r i e n c e d b e i n g c o n t r o l l e d b y others a n d r e c e i v i n g interventions that were incongruent w i t h her needs. D e s p i t e r e g a i n i n g p h y s i c a l health, she indicates that her eating disorder and the u n d e r l y i n g issues continue to " t h r i v e " . S h e has at times feared the c o n t r o l that the eating disorder has had over her. A n d r e a is saddened but r e s o l v e d towards the o n - g o i n g and c o n t i n u e d i n v o l v e m e n t o f A n o r e x i a i n her life. She has d i f f i c u l t y c o n s i d e r i n g her self-identity or life i n its absence, and A n o r e x i a ' s l o n g s t a n d i n g presence i n her life is seen as a "part o f her. S h e has c o m e to define h e r s e l f through her a b i l i t y to c o n t r o l her b o d y and to shape it at her w i l l . S h e faces  85 conflict within herself related to whether she may ever be ready to let go of Anorexia, as it allows her to cope. Through her experience she gains a sense of control, power and satisfaction by defying physiological needs and also defying her heightened awareness of the needs and emotions of others, which she perceives, mirrors and internalizes. A s she felt trapped by her awareness and her feeling of "carrying the weight of the world", she identifies that her eating disorder led to a self-destruction, separating herself from her body and allowed her to no longer have to cope with the elements of her experience that trapped and overwhelmed her. Her experience involves not only restriction of her intake but of her emotions, her attachment to others, and the depth of her experiencing through withdrawal and separation. Denial and defiance of the connection between her mind and body, a connection to her human needs and her reaction towards the world, is related to her experience of Anorexia. A feeling of burden in reaction to the world is overwhelming to her and led to her selfdestruction through Anorexia as a means to cope as she describes:  I love life and I love living it, and you know, it's a wonderful thing, but to also have a large hatred for the world and how it works, and how it you know um whether people think it's fair or unjust and ...its just that I find that as an individual I just feel like just a heavy weight of all problems in the world that I just like, I don 'tfeel like I have to solve them, but I just feel them and I experience them and I just there's ways that eventually you can't take it anymore and you do eventually sort of self destruct  86 Andrea conceptualizes her eating disorder in a metaphorical sense. She sees her experience as a search for something; a hunger represented by starvation and coldness of her body and emotional and spiritual coldness. W i t h Anorexia, as in her desire to accomplish and achieve, she wants to "completely exert" herself, yet is "not wanting to partake so much", wanting to give but not to receive. She indicates that often her times of greatest success are those when Anorexia is dominant in her life. She relates her determination, drive, and perfectionism as fueled by Anorexia as well as the basis for its strength. She describes that through her perfectionism she was led to inevitable self-destruction through her eating disorder. She describes a goal of her eating disorder as not to be "skinny" but to "erase" herself. In her mind it seems that her eating disorder is related to her expectations of herself and her determination to excel and accomplish beyond the ordinary. Anorexia was a source of achievement and success as she sought to achieve her mission "at all cost" and to defy death. Opposing dynamics exist in her eating disorder, which she sees as both a means to gain nurturance, care and attention, but also to separate herself from others and to no longer participate in her life. Andrea feels that her family environment was incongruent with her needs, that she was parentified, and did not internalize the care that she did receive. She identifies an awareness of her differences amongst her peers, her heightened emotional awareness, and attention from others on a superficial level as part of what she was escaping from through her eating disorder.  87  Being so sociable, and just being around people all the time, and to be an object of desire to the opposite sex, ...I didn 't want a part of that anymore. I didn 'tfeel, I just kind of wanted to get away from everything and, just kind of separate myself from the physical world I guess... I remember thinking that I wanted to be alone, that I wanted nothing of this, I don't want any emotion, I don't want to have to deal with things.  She acknowledges a sense of mission and purpose while engaging in her eating disorder. She indicated that she has found purpose, meaning and appreciation of the value in her experience of Anorexia, although she is conscious of not wishing anyone else to endure such an experience. Andrea sees her eating disorder as a way to have "recreated" herself, to reevaluate and learn about herself and to become more "grounded". She sees her experience of Anorexia as self-destruction as a means to excel or for a greater purpose. She relates necessary self-destruction and resulting higher functioning or "something bigger" to other issues of psychological distress throughout her life. Her "hunger", "constant thirst" or search for something throughout her experience of Anorexia has not been satisfied although her journey is clear.  My disordered eating was almost a search for something . ..separation for mind and body. ..ifl  was just a mind, then... I would find that something.  Andrea continues to search.  88  Phoenix It was like a different species of eating disorder almost...Like throughout the whole thing numerous doctors had said, she's not the textbook case and they didn 't know what to do either.  P h o e n i x ' s experience w i t h A n o r e x i a is one o f repetitive c y c l e s o f severe r e s t r i c t i o n o f intake, e s c a l a t i o n o f her eating disorder struggle, p h y s i c a l deterioration a n d several h o s p i t a l i z a t i o n s a n d a d m i s s i o n s to inpatient E a t i n g D i s o r d e r Treatment C e n t r e s . A t the height o f her struggle she w a s c o n s u m e d b y eating disorder b e h a v i o u r s a n d thoughts, a n d s a w her eating d i s o r d e r as c o n t r o l l i n g her. S h e refers to an eating disorder v o i c e , "the e x e c u t i o n e r " , as p e r v a s i v e a n d strong, a n d felt that her e v e r y a c t i o n , thought a n d f e e l i n g w a s " c h o r e o g r a p h e d " b y the v o i c e a n d her eating disorder. S h e has d i f f i c u l t y a r t i c u l a t i n g her e x p e r i e n c e v e r b a l l y , as she v i s u a l i z e s m u c h o f her experience o f A n o r e x i a . S h e sees her e x p e r i e n c e o f A n o r e x i a as a search f o r m e a n i n g , purpose a n d c o n t r o l . P h o e n i x sees the t u r n i n g p o i n t i n her struggle w i t h A n o r e x i a as o c c u r r i n g w h e n the purpose o f it i n her life b e c a m e clear to her. S h e sees her experience as not related to c a u s a l factors b u t to a necessary purpose i n her life. S h e anticipated that she w o u l d e x p e r i e n c e s u c h a c r i s i s , b r i n g i n g authenticity a n d depth to her e x p e r i e n c i n g , v e r b a l a n d e m o t i o n a l e x p r e s s i o n . R e s t r i c t i o n o f e m o t i o n , e x p r e s s i o n a n d e x p e r i e n c i n g p r i o r to her e a t i n g d i s o r d e r h a d been i n c o n g r u e n t w i t h the depth at w h i c h she n o w feels she w a s meant to l i v e . A n o r e x i a ' s purpose w a s to facilitate a n d enable that l e v e l o f depth a n d e x p r e s s i o n i n her life. A l a c k o f true c o n n e c t i o n w i t h others, a l o n g w i t h f e e l i n g different a n d i s o l a t e d h a d o c c u r r e d .  89 She relates her eating disorder and progression to recovery to now being able to experience connections with others and to feeling and expressing her emotions more fully. Phoenix explicitly links giftedness to her experience of Anorexia and to perfectionist and obsessive qualities, which fueled her struggle. She has an awareness of her differences amongst her peers, particularly when encountering other individuals struggling with eating disorder issues. It seems that the uniqueness in her struggle was recognized by treatment providers and contributed to a sense of frustration in response to her eating disorder presentation. She feels that giftedness "puts a whole different spin on things", and that her eating disorder "just felt like a totally different subject matter" and a "different species" of eating disorder. The relationship between her eating disorder and giftedness appears to have been related to several ineffective interventions that she received which were incongruent with her needs. Although initially passive in response to treatment, she responded with defiance once she recognized that she could fight back in response to her perceptions of being controlled by treatment providers. She was also defying the "invisible pressure" and expectations of her parents through her eating disorder. Her expectation of herself to be "perfect", and the "unspoken" expectations she felt from her family to conform, and seek perfection, are also related to her experience of Anorexia. She appears to have felt that as an "anorexic" she should also be "perfect" at having an eating disorder. Phoenix indicates that family dynamics, a lack of depth in the experiencing in her family system, an intertwined connection with her mother, and restriction of family communication are all involved in her experience of an eating disorder. These issues benefited from being confronted and challenged.  90  P h o e n i x is aware o f the c o m p l e x i t y o f u n d e r l y i n g factors i n her experience that d i d not relate to thinness o r f o o d .  It was totally not about losing weight or not eating or whatever, it was just a way to control what was going on. It wasn 't like I was trying to lose weight. ...I never had this perfect number in mind, and most other people did.  S h e identifies her eating disorder as " c o n t r a d i c t o r y " , as she felt o p p o s i n g d y n a m i c s and c o n f l i c t w i t h i n h e r s e l f w h e n she was torn between w a n t i n g to r e c o v e r a n d b e i n g u n a b l e to. S h e sees h e r s e l f as " f i g h t i n g getting better and f i g h t i n g not getting better". S h e felt trapped b y h e r eating disorder. P h o e n i x sees h e r eating disorder as a metaphor i n her life. S h e sees A n o r e x i a as a j o u r n e y t o w a r d a l i g h t that w o u l d p r o v i d e c l a r i t y . She conceptualizes her r e s t r i c t i o n o f intake, as w e l l as restriction o f her e x p e r i e n c i n g and e m o t i o n s , as both a force to not eat as w e l l as a force to "stay silent". S h e has d e v e l o p e d a strong sense o f her e x p e r i e n c e h a v i n g purpose a n d h a v i n g been destined. She has c o m e to appreciate the v a l u e o f her eating disorder e x p e r i e n c e , and the awareness a n d l e v e l o f depth o f e x p e r i e n c i n g to w h i c h i t has p r o p e l l e d h e r and her f a m i l y . a person's mind like, it can either be, it can be stuffed with things that don't really mean anything just a bunch of surface things but then with the eating disorder it kind of cleared it all. It was like whoa, I can see now. Just see everything in a total different light.  91 She conceptualizes her eating disorder as a "teacher" that has allowed her to become herself, to experience and express her emotions, to individuate in her family relationships, and to gain strength and authenticity within herself and in relationships with others. She feels that the eating disorder pushed her to confront the issues in her life that would allow her to feel congruent in the depth of her experiencing and feelings and to "find her voice". A s she expresses: "/ have a voice now, hear me roar! "  Emily It's not really about my body at all, even when I was most sick, and depriving myself of food, it wasn 't because I wanted to be thinner, it was because I wanted to take up less space, I wanted to be less, less in the way, less, less of a bother. And the only way to do that would be to take up less space in the world.  E m i l y ' s struggle with Anorexia is one of searching for control of her emotions, and coping with heightened sensitivity to the environment, and to the needs and expectations of others. When overwhelmed with the intensity of her emotions and thoughts, and the pressures and stress of her environment, she focused on what she could control- her body. She sought to have "perfect" control while defying death and her physiological needs. She sees her struggle as one of searching for validation, and a means to deal with her perceived "imperfections". For E m i l y , Anorexia is related to feeling worthless, overwhelming emotional pain, and lack of control. "Emotional traumas" became physical when she was unable to cope in any other way. B y taking away physical sustenance, she was provided with  92  a "crutch" which allowed the withdrawal of energy required to deal with "life around her" and her inner pain.  It was like being in the middle of a hurricane all the time, and so to try and deal with that, I would run and it hurt physically to run, and so I was able to take my concentration from concentrating on the stuff I didn't know how to deal with, into physically beating my body, cause I could deal with that. I could handle the pain of running, but I didn 't know how to handle the pain of all the emotions.  E m i l y began by gradually restricting her intake at a young age. This led to an "obsession" with exercise, severe food restriction, malnourishment, and physical, mental, and emotional deterioration, which resulted in her becoming medically compromised. Although not hospitalized, E m i l y cites one of her goals throughout her eating disorder as hospitalization. This is a goal she still sees as unachieved and as a failure. She felt that i f hospitalized she may prove that she was in control, and may force the attention of those around her to how desperate she had become through the experiences in her environment-a sacrifice of herself to motivate change in her family. Prioritization of the needs of others and sacrifice of her own needs is related to her experience. She maintains that i f she cannot recover for herself, then she may recover for those around her. Her sensitivity and hypervigilance to the environment, her "radio antennae", overwhelmed her and led her to a necessary means to cope and to escape her awareness through Anorexia.  / would refuse to acknowledge my needs in order to take care of somebody else.  93  E m i l y sees her struggle as a metaphor, representing a restriction o f her intake, her e m o t i o n a l reactions, her b o d y , the space she t o o k up i n the w o r l d , and her e x p e r i e n c i n g t h r o u g h w i t h d r a w a l and i s o l a t i o n . She indicates that she has r e c e i v e d interventions that w e r e i n c o n g r u e n t w i t h her needs and became " i n d i g n a n t " i n response to those w h o saw eating disorders as m e r e l y a search for a p h y s i c a l i d e a l or a reaction to m e d i a influences. A m o n g s t other i n d i v i d u a l s w i t h eating disorder struggles she also felt that her experiences w e r e s o m e h o w "different" and that her eating disorder struggle was "deeper". S h e sees her e a t i n g disorder as a r e b e l l i o n and defiance different f r o m " t y p i c a l " g i r l s . S h e is aware o f her differences amongst her peers and what she sees as her " o d d i t y " and " m a t u r i t y " .  Those  differences h a v e l e d to feelings o f i s o l a t i o n and rejection, feelings she r e s p o n d e d to w i t h i n c r e a s e d intensity o f her eating disorder b e h a v i o u r and a w i s h to d i e . S h e tested the l i m i t s o f her p h y s i c a l self and d e r i v e d satisfaction f r o m c o n t r o l o f her b o d y and p h y s i o l o g i c a l responses.  She felt p o w e r as she defied death and the fear a n d  w a r n i n g s for her life c o m m u n i c a t e d to her b y others. She e x p e r i e n c e d c o n f l i c t w i t h i n h e r s e l f w h e n at times she w a n t e d to regain c o n t r o l o f her b e h a v i o u r , yet the eating d i s o r d e r c o n t r o l l e d her. O p p o s i n g d y n a m i c s relate to w a n t i n g to be less o f a "bother", and "less n o t i c e a b l e " through her w e i g h t loss, although she is aware that it was her w e i g h t loss that a l l o w e d her to g a i n the attention and f u l f i l l m e n t o f unmet needs and i n s e c u r i t i e s . S h e sought c o n t r o l i n her life i n response to the " a u t h o r i t a r i a n " c o n t r o l she felt that her father p l a c e d o n her and her f a m i l y . T h r o u g h o u t her experience o f A n o r e x i a , w h e n others attempted to c o n t r o l her, she responded i n quiet defiance b y i n c r e a s i n g the intensity o f her eating d i s o r d e r b e h a v i o r s , or b y a greater determination to continue.  94  I was taking control myself I felt, and in a way that um nobody could take away from me, this was my area, I had control, and I was proving to the world that I had control over myself.  E m i l y experienced her eating disorder as having a voice. She describes the voice as "full of hateful torment", using profanity, and incessantly "accusing" and reminding her of how worthless, ugly, and undeserving she was. She internalized the messages from the voice and the belief that she did not deserve to eat and instead deserved to die.  "I didn 't deserve to eat, I deserved to end up in hospital, I deserved to die. "  A t times in her struggle she felt "at one" with the eating disorder voice, and it was difficult for her to free herself from its grip. She describes experiencing an eating disorder "trance" in which she dissociated from her body and was not present in her conscious experiences. These appear to be times of her greatest pain and fear within herself. E m i l y ' s sensitivity to the environment and others was heightened in her family system. A n intertwined emotional connection with her mother, and feeling controlled by and fear of her father during a time of pain, discord and change were issues that she was coping with through her eating disorder. She indicates that her relationship with her father and his perceived abuse, contradictory messages, and expectations of her were overwhelming and related to her eating disorder struggle. \  95  Perfectionism was a major part of her struggle with Anorexia as she sought to meet high expectations of herself and the perceived expectations of others. Her search for validation and approval led to pervasive and debilitating perfectionism. She indicates that perfectionism played "such a huge part in [her] life everywhere" and in her eating disorder experience. She experienced devastating personal consequences and lowering of self-esteem when she felt that she could not be perfect or reach the unattainable goals that she set for herself. In her quest to be perfect she clung to the idea that Anorexia may be the one thing that she could be perfect at.  I was going to be the ultimate anorexic, I was going to be the anorexic of all or the anorexic of all anorexics... the last option to achieving something for my life was to just... listen to the eating disorder and let that take over.  E m i l y has difficulty accepting her continuing struggle with eating disorder relapse and experience of profound depression as she attempts to challenge emotional issues and to heal the "pain of the past". She is reflective of her experience and has a sense of appreciation and gratitude. Through her struggle she feels that she has learned much about herself, her identity and relationships while reevaluating what is important in life. She has begun to internalize feelings of strength, worth and love through her experience of Anorexia, although she would not wish what she has been through on anyone else.  It's almost worth it to have learned what I've learned.. .but I wouldn't wish what I've been through on anybody.  96  Grace  The idea that I should have a perfect life. ..when I felt that I couldn't I had to make at least part of my life perfect and I could be really, really healthy...  Grace's struggle with Anorexia is one of a search for control while other areas of her life were perceived as out of her control. She has found meaning in the experience of her eating disorder and come to appreciate the value of it in her life. Grace sought control of her body and health when she felt trapped by pressures of her environment, which were incongruent with her needs. She experienced feelings of desperation, worthlessness, pain and fear as she struggled with the pressure to live up to her "potential". She began to cope through her eating disorder. She is unsure of how the eating disorder "caught o n " , yet once it did, it dominated her life and consumed her. She felt unable to let go on her own, and at one time felt that her only way out of Anorexia would be to die. W h i l e she came to Anorexia to escape from feelings of being trapped, she then became trapped by Anorexia itself.  I hated it so much and I really, really wanted out, but I didn't see any road out because getting over it was just way too hard and I felt like the only way out was to die.  Grace explicitly links giftedness to her experience of Anorexia, and to the perfectionism that fueled its existence. Feelings of worthlessness arose as she felt that she did not deserve either "her gift" or to eat. She believes that giftedness played a "major part in [her] getting sick" and her eating disorder represented something that she could excel in  97  when she perceived herself as a failure. The pressure that she felt to excel, perform, and to live up to her gifted "potential" led her to feel trapped and to seek control of something; to be perfect at something. She derived a sense of meaning and feelings of happiness, satisfaction, and superiority from her ability to defy her physiological needs and to starve.  I think with the giftedness, there's at least some perfectionism that kicks in, and since I couldn't be anywhere close to perfect in any other areas of my life, eating was one area I could be "perfect", and I felt like that too. I felt better than other people, because I could control myself, my hunger, my body. It made me feel superior to others.  Her eating disorder allowed her to cope, yet in turn led to desperation, a progression and escalation of her struggle, severe restriction of her intake, physical deterioration and hospitalization, both for suicidal behaviour and treatment of her eating disorder. She expresses an awareness of opposing dynamics and conflict within herself that is characterized by satisfaction and coping through Anorexia, but contrasted with the pain and desperation of her struggle. She is aware that her eating disorder controlled her, and felt that only in giving control to others would she regain hope for her future, for a life free of Anorexia and free of the wish to die to escape her pain and hopelessness. She sees giftedness as both related to personal characteristics underlying her eating disorder dynamics, but also to the reasons why she found herself in a gifted program in which she felt trapped, pressured, invalidated, and where her emotional needs were neglected. She anticipated a crisis and was aware of her deterioration, both physical and  98  psychological. Through her eating disorder she was coping with her environment, emotional pain, void in her life, and pressure to "be an adult" and to perform to her "potential". Grace experienced a preoccupation with being "healthy", and became distressed by her thinness. She did not believe that a certain weight would bring happiness. It was the process of starvation through which she gained control and a focus on something other than her distress and desperation. A fear of fat in her body or intake led to preoccupation with eating "perfectly", and the feeding of and caring for others. Grace identifies her family dynamics as playing an important role in her eating disorder. She prioritized the needs of others, and felt responsible for her family and the "holes" that she saw in it. She played the role of "parent", as she felt she needed to hold the family together. She became consumed with caring for them, and by her eating disorder behaviour and continuous "thinking".  Her need to be the "sick one" and her family  experience relates to her experience of Anorexia, as she was aware that she could not fight against it in an environment that was incongruent with her needs. She knew she needed to learn to take care of herself and separated herself from them to do so. She feared that change in her eating disorder could not be maintained if the environment in which it developed did not change. Throughout her struggle Grace experienced intense feelings of guilt related to the burden she perceived that she brought to the lives of others around her. Worthlessness, low self-esteem and internalization of the invalidation she experienced in the gifted program relate to her experience of Anorexia. Grace has an awareness of her difference from others throughout her life. She isolated herself and feared socialization, since she felt she would be required to "put on her face" and  99  m a s k her true self a n d c o m p l e x i t y . H e r eating disorder is related to her r e s t r i c t i o n o f her e x p e r i e n c e a n d i s o l a t i o n . S h e w a s able to f i n d c o n n e c t i o n w i t h others w h o also struggle throughout her e x p e r i e n c e o f eating disorder treatment a n d c o n f r o n t i n g the issues at its root. H e r expectations o f perfection for herself, a n d to be "the best", c o n t r i b u t e d to her d e t e r m i n a t i o n to be perfect at her eating disorder. H e r d e t e r m i n a t i o n to succeed, h o w e v e r , then b e c a m e a d e t e r m i n a t i o n to let g o o f her eating disorder. S h e finds a c o n t r a d i c t i o n i n b e i n g grateful f o r A n o r e x i a i n her l i f e , as it b r o u g h t w i t h it " h e l l " , p a i n a n d struggle. T h r o u g h her experience she has c o m e to appreciate the v a l u e a n d purpose o f A n o r e x i a i n her life. S h e feels that she has learned m u c h t h r o u g h her struggle a n d w i l l carry that w i s d o m throughout her life. S h e a c k n o w l e d g e s that the eating d i s o r d e r f o r c e d her to stop, reevaluate a n d to gain the s e l f - k n o w l e d g e r e q u i r e d to care f o r herself, to engage i n the w o r l d a n d r e l a t i o n s h i p s , to learn w h o she is a n d what she does a n d does not need. A n o r e x i a is the m e t a p h o r i c a l "train w r e c k " that altered the course o f her l i f e a n d experiencing.  Just to have been able to have like a train wreck stop that and everything and be able to decide how I wanted to live my life it was really valuable.  Mary "It's very annoying being a perfectionist,  it really controls you, and it can drive you  insane because you're never perfect, it's never perfect when you're a perfectionist. "  M a r y ' s struggle w i t h A n o r e x i a is one o f searching f o r happiness, self-acceptance, self-esteem a n d the "perfect M a r y " . T h i s search a n d a quest f o r a p h y s i c a l i d e a l , a n d c o n t r o l  100 of her body, promised her many things but instead created conflict within herself as she became controlled by her eating disorder. Feelings of despair, self-consciousness, and not being "good enough", worsened throughout her experience. She initially looked to her eating disorder as solution, a means to feel better about herself, and to distance herself from the incessant comparisons she made of herself to others. She was unable to find what she was looking for through Anorexia.  "I don't know if it was the journey to find the perfect 'Mary' or what, but I didn 'tfind it." M a r y began severe restriction of her intake, and excessive exercise in an effort to focus on herself, her appearance and physical performance by becoming more "fit". She experienced physical and emotional deterioration, became medically compromised, and was hospitalized. Her determination to succeed was present in her daily preoccupation with food restriction and exercise. She feared the control that the eating disorder had of her, but was trapped by conflict within herself and opposing dynamics which led her to fear gaining weight or losing any more, a "battle within [her] brain". Throughout her experience she remained aware of her physical emaciation and was distressed by her thinness, although she denied the severity of her health risk. She experienced fear and self-consciousness related to the physical deterioration of her body. She felt that a crisis of some kind would be the only means through which she may be loosened from Anorexia's grip. Fear- and hospitalization represent that crisis and a turning point in her struggle. In M a r y ' s experience of Anorexia, restriction of her intake, her emotions and her experiencing by isolation from her family and peer relationships occurred. She  101  conceptualizes her eating disorder as an " e v i l " part of her brain, which "twisted reality", and took over her life. Anorexia "ridiculed" her and made her feel worthless, although it allowed her to cope with profound depression and emotional pain, which she continued to mask. She feels that her depression and negative self-concept were a "major factor in getting the whole eating disorder started". Throughout her experience she felt void of emotions, although the emotional numbness that she felt was preferable to her than the emotional pain and depression in her experience.  / was very quiet and didn't show much, didn't have much emotion at all, I was kind of emotionless actually, more than anything.  Fear motivated her to use the determination and focus she had utilized to engage in her eating disorder to fight it instead. Her expectations of herself to be "exceptional", to "succeed", and to be "perfect" were shadowed by her feelings of self-hatred and criticism. Competitiveness and perfectionism, which were underlying factors in her experience, presented a dilemma of inevitable failure as she sought to be good enough for herself. H i g h expectations in all aspects of her life relate to a desire for happiness and self-acceptance, factors interconnected with coping through her eating disorder. If she could not be good enough for herself she sought happiness and esteem by meeting the needs of others. M a r y sacrificed her self and her needs, which took its toll on her identity.  102  "it got to the point where I sacrificed myself to make other people happy... then it just got to the point where there was no me and I wasn 't really anything for myself anymore."  Restriction of emotional expression was present in her experience of Anorexia and also in response to her eating disorder by others. She remarks on the "silence" of her family and friends through her struggle. She appears to feel that her family dynamics are not typical of those who experience disordered eating although she cites a family history of depression, and disordered eating as related factors. M a r y relates giftedness to her experience of Anorexia through a connection to her continual search to accomplish and excel. Her poor self-esteem has not allowed her to internalize her successes and through her eating disorder she sought to compensate for her perceived inadequacies.  "it can be like a black cloud over your head, and you keep striving but there's a point when you can't do any better than you already are. And that's when you look to other things to do better, to compensate for what you can't do better at."  M a r y has experienced anger at her self for allowing Anorexia into her life and giving it the opportunity to " k i l l " her when she should have "known better". She is cognizant of the irony related to how the idealized solution to her emotional pain, depression, and lack of selfacceptance and self-worth "backfired" and became a battle in itself.  103  A l t h o u g h M a r y has regained p h y s i c a l health she continues to struggle. S h e b e l i e v e s that her e x p e r i e n c e o f A n o r e x i a was purposeful and happened for a reason. S h e has c o m e to appreciate the v a l u e o f the eating disorder i n her life and what it has b r o u g h t her i n c l u d i n g a stronger identity, self- k n o w l e d g e and personal g r o w t h .  "if it doesn 't kill you it makes you stronger! Almost  literally."  M a r y continues to search for the happiness falsely p r o m i s e d b y A n o r e x i a .  Feedback from  Participants  Situated structures were sent to each o f the participants. T h e response f r o m t h e m was o v e r w h e l m i n g l y p o s i t i v e , and none sought to clarify any themes or aspects o f their experience. M a n y reflected o n h o w their experience had been captured f u l l y a n d that they d i d not want to change a n y t h i n g . S e v e r a l c o m m e n t e d that it had been a p o s i t i v e e x p e r i e n c e for t h e m to see the essence o f their experience i n this format and that it h a d c a u s e d t h e m to c o n s i d e r themes i n their experience o f an eating disorder that they h a d not f u l l y u n d e r s t o o d or c o n s i d e r e d p r i o r to n o w .  General Structure: Final Themes and Sub-Themes T h e general structure o f the experience o f an eating d i s o r d e r a m o n g the s i x gifted adolescent female participants f o l l o w s . T a b l e 1 outlines the m a i n themes and sub-themes w h i c h represent the core and c o m m o n themes o f the experience. E a c h theme a n d the associated sub-themes are d e s c r i b e d and excerpts f r o m the participant i n t e r v i e w s are p r o v i d e d to a d d depth a n d the v o i c e s o f the participants to the presentation o f the f i n a l themes.  104  T a b l e 1: T h e E x p e r i e n c e o f an E a t i n g D i s o r d e r A m o n g G i f t e d F e m a l e A d o l e s c e n t s : M a i n T h e m e s and Sub-Themes  M a i n Themes  Sub-Themes  Negative Affect and Self-Perceptions, Emotional Pain and Deterioration Fear Depression, Desperation and Hopelessness Anger and Frustration Guilt, Blame, and Burden Worthlessness, L o w Self-Esteem and Critical of Self Physical, Cognitive, and Emotional Deterioration Continuous Struggle Hospitalized/Medically Compromised  Overwhelmed and Conflicted Trapped and Pressured Conflicting and Opposing Dynamics  Not Fitting: Incongruence and Awareness Differences Incongruence in the F a m i l y System  C o p i n g Through Engaging i n the Eating Disorder Eating Disorder as a Solution  Experience of Giftedness and Eating Disorder and/ or Struggle Explicitly Connected Heightened Awareness/Sensitivity  Perfectionism- Striving to Attain "Perfect" G o a l of Perfect A n o r e x i a Expectations Determination and Focus  /  105  Control and Restriction Personal Quest for Control Controlled by Others Controlled and Consumed by Eating Disorder Restriction of Intake Restriction of Emotions Restriction of Experience  Awareness of Multifaceted Underlying Factors Experience the Eating Disorder as N o t About Food or Weight  Sacrifice, Defiance and Separation: O f Self and Identity, of Body, and of Needs Sacrifice Prioritize Needs of Others Defiance and Denial Separation and Dissociation Defining of Self and Identity Issues Experience of Eating Disorder V o i c e Externalization of Eating Disorder  Purposeful, Appreciated and Meaningful Experience Appreciation and Recognition of the V a l u e of the Eating Disorder Experience Purpose and M e a n i n g Eating Disorder as a Metaphor Searching  Theme 1: Negative Affect and Self-Perceptions, Emotional Pain, and Deterioration T h e e x p e r i e n c e o f an eating disorder a m o n g the participants i n c l u d e s negative affect, negative self-perceptions, e m o t i o n a l p a i n and deterioration.  T h e p r o f o u n d l y negative  feelings and perceptions are pervasive and relate to internalization o f p a i n f r o m the e n v i r o n m e n t , as w e l l the personal e m o t i o n a l p a i n that resides w i t h i n the i n d i v i d u a l . T h e  106  deterioration that occurs among these young women is physical, cognitive and emotional and relates to a progressive worsening and escalation of the eating disorder experience. Esprit describes the scope of her pain that she internalizes from the world around her. The pain of finding  your place  in the world and the universe.  Trying  beyond yourself, trying to make sense of things, not understanding things happen, actually  unfairness.  goes on in everyday  The conflict  between  life [begins to  our best intentions  to...  things, and  why what  cry].  Sub-themes within this category represent specific factors that relate to negative affect and perceptions of self, as well as emotional pain and are part of the experience of an eating disorder for several participants. These sub-themes include: Fear: Depression, Desperation and Hopelessness: Anger and Frustration: Guilt, Blame, and Burden: Worthlessness, L o w Self-Esteem, Critical of Self; Continuous Struggle; and Hospitalized/ Medically Compromised. A l l participants referred to experiencing Fear. This is often related to a fear of a continuing struggle with their eating disorder, the eating disorder's severity, or the control that it has over them. Several participants describe a fear of letting go of the eating disorder, or of being themselves. M a r y expresses her fear related to her emaciated physical state. "I did see myself as really skinny, it scared me ".  Esprit describes her fear of the possibility of a life long battle with her eating disorder.  107  There are days when you ... you worry that oh my god is it always going to stay like this, I have always been like this, I am like this, I will always be like this.  Feelings of Depression, Desperation and Hopelessness relate to the experience of Anorexia for most of the participants. Mary describes how depression is related to her struggle with her eating disorder. "the depression was a major factor in getting the whole eating disorder started".  Grace describes the desperation, depression and hopelessness that she felt as she struggled to deal with her eating disorder and considered whether she could continue her life in its grips. "I'd get progressively depressed, depressed, and more depressed".  I was just like I was so desperate to stop the pain... cause I just felt like I was in so much pain all the time and I was always thinking. And everything was always wrong.  I felt like if I spent the night at home that I would get up in the middle of the night and try and bus downtown and get a gun because I felt just so desperate to stop thinking and to stop feeling all this pain of being sick.  108 S e v e r a l participants referred to e x p e r i e n c i n g A n g e r and F r u s t r a t i o n as an aspect o f their eating disorder experience. F e e l i n g s o f anger and frustration were t y p i c a l l y d i r e c t e d towards themselves for s t r u g g l i n g , h a r m i n g themselves, h a v i n g b e g u n to engage i n e a t i n g d i s o r d e r b e h a v i o u r , or c o n t i n u i n g to struggle w i t h eating disorder issues. A n g e r and frustration were also directed at others for c o n f r o n t i n g t h e m or t r y i n g to c o n t r o l their eating or e x e r c i s i n g b e h a v i o u r s . F r u s t r a t i o n was also related to the i r r a t i o n a l nature o f the eating d i s o r d e r and h o w it c o n t i n u e d to be present i n their l i v e s . P h o e n i x refers to the frustration she e x p e r i e n c e d as she evaluates w h y the eating d i s o r d e r m a i n t a i n e d its p l a c e i n her life.  I'm doing this again and again and again and yet why? Why am I not doing it? Why is nothing getting solved?  F e e l i n g s o f G u i l t , B l a m e and B u r d e n related to the e x p e r i e n c e o f A n o r e x i a a m o n g the majority o f the participants. M a n y o f the participants refer to f e e l i n g g u i l t y about the effect that the eating d i s o r d e r has o n those around them, f e e l i n g b l a m e d b y others or b l a m i n g themselves for their eating disorder, or f e e l i n g that they are a b u r d e n to those a r o u n d t h e m . T h e m a j o r i t y o f the participants express feelings o f W o r t h l e s s n e s s , L o w S e l f - E s t e e m , and are C r i t i c a l o f Self. T h i s sub-theme seems to reflect the p a r t i c i p a n t ' s negative feelings about themselves and d e v a l u a t i o n o f their o w n w o r t h . M a n y participants i n d i c a t e f e e l i n g that they are not d e s e r v i n g , are h a r s h l y c r i t i c a l o f themselves, or f e e l i n g that they are n e v e r g o o d enough.  E m i l y and M a r y describe h o w worthlessness and l o w self-esteem relate to their  e x p e r i e n c e o f their eating disorders.  109 I didn 'tfeel that I deserved to live ...I didn 't deserve to eat, I deserved to end up in hospital, I deserved to die.  I'm just never good enough. And I always wanted to be better.  C r i t i c i s m o f themselves also extends to what appears to be seeing themselves as out o f the o r d i n a r y , for e x a m p l e descriptions o f themselves that i n c l u d e " w e i r d " , " c r a z y " , " b i z a r r e " or, " a b n o r m a l " , "too smart". T h e participants experience a progressive deterioration i n the p h y s i c a l , c o g n i t i v e and e m o t i o n a l sense, and a w o r s e n i n g and escalation o f their eating d i s o r d e r struggle. Participants reflect o n a C o n t i n u o u s Struggle, w i t h their eating disorder a n d several c y c l e s o f relapse, r e v e r t i n g to u s i n g eating disordered b e h a v i o u r to cope, and the b u r d e n o f a d a i l y , m o m e n t - t o - m o m e n t struggle w i t h disordered eating c o g n i t i o n s and b e h a v i o u r s . A f e e l i n g o f b e i n g defeated b y the eating disorder is present i n the experience o f m a n y participants. T h e sub-theme o f b e i n g H o s p i t a l i z e d / M e d i c a l l y C o m p r o m i s e d is an aspect o f the e x p e r i e n c e o f the eating disorder for a l l o f the participants. A l l participants refer to the severity o f the p h y s i c a l deterioration o f their b o d i e s , and to their p h y s i c a l health b e i n g c o m p r o m i s e d s i g n i f i c a n t l y . W i t h the e x c e p t i o n o f one participant, a l l were h o s p i t a l i z e d for s o m e length o f t i m e , or o n m o r e than one o c c a s i o n as a result o f m e d i c a l r i s k associated w i t h their eating disorder. T h e r e m a i n i n g participant also suffered s i g n i f i c a n t m e d i c a l c o m p l i c a t i o n s and e m e r g e n c y m e d i c a l interventions.  110  Theme 2: Overwhelmed and Conflicted The experience of an eating disorder involves feelings of being overwhelmed within themselves and also by external sources in the environment. There is a strong sense that their experience is too much to take, and a need to escape the feelings or situations that threaten to overwhelm them. Participants refer to being overwhelmed by many factors, for example being overwhelmed by their emotions, heightened sensitivities, and the state of the world around them. Participants also refer to internal opposing dynamics and conflict within themselves that relate to their eating disorder experience. Andrea describes being overwhelmed by her heightened sensitivities and emotionality. I wanted to shut it down just because I find that despite how much I don't want to be, I have always been very emotional, very in touch with things ... in some ways too much. But I just didn't want to handle things anymore.  A salient sub-theme within this category includes specific reference by many of the participants to feeling Trapped and Pressured. Participants discussed feeling trapped or pressured by the expectations of themselves, or that others have for them or by their environments. Participants often express being trapped by their eating disorder, as Phoenix and Grace do here: It's like, if you want to get better then why are you still doing these things, why don't you just try harder. And it's like you can't, you just can't.  Ill  Just the pain of thinking all the time, of feeling like there was no way out because I did feel trapped.  A l l participants describe C o n f l i c t i n g and O p p o s i n g D y n a m i c s throughout their eating d i s o r d e r e x p e r i e n c e . T h i s represents f e e l i n g torn, and the p u s h and p u l l o f o p p o s i n g forces w i t h i n themselves and i n response to their eating disorder. T h i s sub-theme represents the inner struggle that characterizes the experience o f disordered eating for the participants. M a n y participants refer to the i n a b i l i t y to let go o f their eating d i s o r d e r despite w a n t i n g to, and a c k n o w l e d g e a c o n f l i c t that arises between the depth o f their e x p e r i e n c i n g , yet f o c u s o n p h y s i c a l attributes. Participants also describe a " l o v e - h a t e " r e l a t i o n s h i p w i t h their eating disorder, s u c h as f e a r i n g the effects o f the eating disorder o n their b o d i e s a n d l i v e s , yet w a n t i n g to m a i n t a i n its r o l e i n their l i v e s . S o m e participants describe the functions that the eating d i s o r d e r serves i n their l i v e s as c o n f l i c t i n g and o p p o s i n g . A n d r e a describes h o w her eating disorder satisfied t w o opposite and o p p o s i n g needs. T h i s o p p o s i t i o n o f needs created c o n f l i c t w i t h i n her as she struggled to understand her eating d i s o r d e r and the r o l e o f it i n her life.  / didn't really understand ... what I was doing because I wanted to be erased and to talk to no one and to be alone, and at the same time I wanted people to worry and to nurture me.  P h o e n i x describes the " c o n t r a d i c t o r y " nature o f eating disorders and also describes her experiences o f b e i n g caught between the o p p o s i n g forces o f w a n t i n g to r e c o v e r a n d also w a n t i n g to r e m a i n engaged i n her eating disorder.  112  In my opinion, eating disorders are really contradictory things. Maybe you think one thing and do another and do one thing, think another  I was fighting a whole bunch of different things. I was fighting getting better and I was fighting not getting better.  Theme 3: Not Fitting: Incongruence and Awareness of Differences A l l participants refer to an awareness of how they often do not fit in their environments (i.e. family or peer group), or that they experience incongruence within themselves. M a n y participants refer specifically to incongruence between the eating disorder interventions that they received and their needs in those settings. Several participants also referred to how they were aware of a difference in their eating disorder experience i n comparison to other young women whom they met that were also struggling with eating disorders. It seems that others also, at times, recognized their differences in their eating disorder experience and not fitting in. Phoenix describes her awareness of the differences in her eating disorder experience, which was noticed by other professionals, and how the differences relate to many of the interventions that she received which she felt were incongruent with her needs. It just felt like a totally different subject matter... It was like a different species of eating disorder almost.  Esprit expresses how her eating disorder relates to the experience of not fitting i n , and how her eating disorder was a means for her to fit in, in a more general sense.  113 There was always a kind of sadness and pain associated with not fitting in and also being chubbier than the other kids so maybe at some point I thought well maybe if I lose some weight...  W h e n I a s k e d E s p r i t about her experience o f f e e l i n g different she f i n i s h e d m y sentence w i t h the r e p l y : [feeling different] is at the heart of a lot of my problems...if not... probably one of the most important factors.  A l l participants e x p l o r e d f a m i l y factors that p l a y e d a role i n the e x p e r i e n c e o f the eating disorder. A l t h o u g h f a m i l y factors i n a general sense were a p r e d o m i n a n t theme, the specific characteristics o f f a m i l y related factors were less u n i f o r m . T h e m o s t c o m m o n f a m i l y related factors are s u m m a r i z e d as an incongruent e n v i r o n m e n t , and a f a m i l y s y s t e m not adequately m e e t i n g the needs o f the y o u n g w o m e n e x p e r i e n c i n g the eating disorder. T h i s element o f the eating disorder experience is represented i n the sub-theme, I n c o n g r u e n c e i n the F a m i l y S y s t e m . Incongruence exists i n the sense that the eating d i s o r d e r represents s o m e t h i n g that is not w o r k i n g i n the f a m i l y s y s t e m , or i n c o n g r u e n c e b e t w e e n the needs o f the y o u n g w o m e n and the f a m i l y ' s capacity to meet them. S o m e o f the m o r e s p e c i f i c c o m m o n factors r e l a t i n g to f a m i l y i n c l u d e : f e e l i n g b l a m e , c r i t i c i z e d , c o n t r o l l e d , or r e s p o n s i b l e for the needs o f f a m i l y m e m b e r s .  114 Theme 4: Coping Through Engaging in the Eating Disorder A l l participants refer to how their experience involved coping through engaging i n their eating disorder with various internal and external factors. Participants primarily refer to the eating disorder as a means to cope with emotional pain absorbed from the environment and that resided within them. Participants also refer to coping with pressure to live up to their potential, feelings of worthlessness, change, stress, and their reaction to the world through their eating disorder. E m i l y refers to the overwhelming emotional pain that she experiences and how her eating disorder experience involves coping. it was like being in the middle of a hurricane all the time, and so to try and deal with that, I would run and it hurt physically to run, and so I was able to take my concentration from concentrating on the stuff I didn't know how to deal with, into physically beating my body, cause I could deal with that. I could handle the pain of running, but I didn't know how to handle the pain of all the emotions.  A s the eating disorder allowed the participants to cope, it also functioned a s a solution to something that the participants were searching for. The sub-theme, Eating Disorder as a Solution, reflects the participants' conceptualization of their eating disorder as bringing something to their lives that was absent or fulfilling an unmet need. The eating disorder was hypothesized to allow them to feel or experience something that they felt unable to before. The participants were often searching for something, for example, for happiness or to fit in  115  and the eating d i s o r d e r was seen as a s o l u t i o n to those things. T h i s was often later r e c o g n i z e d as a false p r o m i s e w i t h w h i c h the eating disorder tempted the y o u n g w o m e n .  Theme 5: Experience of Giftedness and Eating Disorder Explicitly Connected T h e participants s p e c i f i c a l l y related their experience o f an eating d i s o r d e r to their giftedness w i t h o u t p r o m p t i n g . Participants appeared to have v a r i o u s l e v e l s o f e x p e r i e n c e w i t h c o n c e p t u a l i z i n g h o w their giftedness fits w i t h their eating disorder e x p e r i e n c e . S e v e r a l i d e n t i f i e d the c o n n e c t i o n between giftedness and eating disorders as important, a l t h o u g h it was a r e l a t i o n s h i p they c o n t i n u e to e x p l o r e and attempt to understand. S o m e o f the y o u n g w o m e n describe their experience o f an eating d i s o r d e r as an e x p r e s s i o n o f gifted issues, w h i c h they identify as self-doubt, pressure (internal and external), p e r f e c t i o n i s m , worthlessness, depression, and heightened sensitivities. M a n y participants felt that the depth o f their e m o t i o n a l e x p e r i e n c i n g and c o m p l e x e m o t i o n a l needs related to giftedness, and were not met or understood i n their e n v i r o n m e n t s . P h o e n i x addresses h o w her giftedness contributed to h o w her eating d i s o r d e r d i d not "fit the m o l d " , and h o w the interventions she r e c e i v e d d i d not meet her needs.  Giftedness just puts a whole different spin on things. It's like, for one reason, doctors don't know what to do with you... at least for me.  E s p r i t refers to giftedness, " i n s i g h t " and " c a p a b i l i t y " as " y o u r greatest f r i e n d or y o u r greatest e n e m y " . E s p r i t e x p l i c i t l y relates her experience o f A n o r e x i a to her giftedness a n d struggles w i t h the m e a n i n g o f the c o n n e c t i o n and h o w it contributes to the struggles that she  116  faces in her life. Esprit also considers the struggles that she sees amongst other gifted individuals, and questions whether they are all "doomed".  The connection between the kind of increased sensitivity, self-consciousness,  self-doubt, insecurity, perfectionism and being gifted, talented, successful... think there is a connection with that and then the eating disorder is just an expression of the self-consciousness and perfectionism and that sort of thing that results when there are other contributing factors as well.  One of the reasons that I am really excited about this research is because I  think that it may have something to do with, that there is a connection betwee my sensitivity and kind of being more of like a sponge.. In between that and being more prone I guess to having problems, not just eating disorders but depression as well (sighs).  A salient sub-theme that relates to participants' experience of their eating disorder and its relationship to giftedness is Heightened Awareness and Sensitivity. M a n y participants relate their giftedness to their awareness of "subtleties" in their environment, and a feeling of responsibility for the world and others around them based on their heightened awareness. In that sense several participants appear to feel the "weight of the w o r l d " on their shoulders, and to "perceive more or see more than others". The experience of Anorexia is specifically related to trying to escape, or being overwhelmed by this sensitivity and heightened awareness. Several participants identify internalizing and mirroring the needs of  117  others, while being extremely sensitive to change and the emotional environment around them. - Andrea refers to her sensitivity and internalization of the world around her. / guess I dunno its just that I find that as an individual I just feel like just a heavy weight of all problems in the world that I just like I don 'tfeel like I have to solve them but I just feel them and I experience them.  Esprit also comments on how her sensitivities and perceptions of the world contribute to her eating disorder and the pain that she experiences in her life. That's why I think that anorexia is connected closely with my perceptions of the world or sensitivities and that's sort of what I mean by too much for my own good and maybe if I had less of that I wouldn 't have as much pain in my life.  Theme 6: Perfectionism- Striving to Attain "Perfect" A n enduring theme throughout the experience of an eating disorder for all of the participants was perfectionism. Perfectionism is reflected in a need to be the best, or striving for perfection although never feeling good enough. Perfectionism is related to selfdestruction, and eating disorders are seen as being another area of life that the participants could "control perfectly", or an area in their lives in which they could be "perfect". Perfectionism is conceptualized as "fueling" the eating disorder. Several participants refer to the relationship between perfectionism and giftedness, as well as relating perfectionism specifically to their eating disorder experience.  118  E m i l y ' s e x p e r i e n c e w i t h p e r v a s i v e perfectionistic thoughts and expectations o f herself is d e s c r i b e d : I shouldn 't have let myself be imperfect. I was not supposed to be letting myself make mistakes.  M a r y describes h o w her need to be perfect threatens to o v e r w h e l m her, a n d is i n v o l v e d w i t h her eating disorder struggle. • Because you can't be obsessive about everything, you can't be perfect in everything, and when you're trying so hard to do that eventually you just kinda implode...  A n d r e a describes h o w p e r f e c t i o n i s m relates to i n e v i t a b l e self-destruction, w h i c h is h o w she c o n c e p t u a l i z e s her eating disorder experience. ...Being obsessive and perfectionistic, and all that kind of stuff... eventually it's a recipe for self-destruction.  A sub-theme o f p e r f e c t i o n i s m , the G o a l o f "Perfect A n o r e x i a " is present a m o n g the m a j o r i t y o f the participants. S e v e r a l o f t h e m e x p l i c i t l y describe a desire to a c h i e v e "Perfect A n o r e x i a " or to be the "Perfect A n o r e x i c " . P a r t i c i p a n t s ' expectations o f themselves to be perfect, and a d r i v e towards p e r f e c t i o n i s m , extend to their eating d i s o r d e r e x p e r i e n c e . T h e y feel that i f they are g o i n g to have an eating disorder they strive to e x c e l at it, be perfect a n d the best at it. T h e g o a l o f "Perfect A n o r e x i a " also appears to relate to s e a r c h i n g f o r s o m e t h i n g i n w h i c h they m a y experience " p e r f e c t i o n " , w h e n they feel that they d o not meet  119  standards of perfection in other areas of their lives. Grace explored how her eating disorder was something that she felt that she could be perfect at when she felt imperfect in other areas of her life Since I couldn't be anywhere close to perfect in any other areas of my life, eating was one area I could be "perfect", and I felt like that too.  E m i l y describes her determination to be the "Perfect Anorexic": I was going to be the ultimate Anorexic.  I was going to be the Anorexic of all  or the Anorexic of all Anorexics.  The sub-theme Expectations is prevalent throughout all of the participants' experience of their eating disorder. Several participants explore expectations that they have of themselves and also that others have of them. Expectations that they have of themselves are often extremely high, perfectionist, and relate to expectations of being extraordinary, to succeed, to excel "beyond average" and to live up to an "image" of themselves that they envision. A m o n g some of the young women the expectation that they should be able to recover more quickly than others, or that they should be able to "figure out" the eating disorder, is present in their experience. Expectations from others are often related to being perfect, to conform, or to be different than they are. Esprit describes how expectations, perfectionism, and trying to live up to the image that she had created, relate to her experience of Anorexia.  120  I think it is just a lot of expectations. I don't know if... it is perfectionism. I think that it has something to do with my eating disorder is that I am trying to live up to this image of me.  A f i n a l sub-theme that relates to p e r f e c t i o n i s m is D e t e r m i n a t i o n and F o c u s . D e t e r m i n a t i o n and focus often relate to both the eating disorder d y n a m i c a n d also a quest to e x c e l , a c h i e v e and a c c o m p l i s h . T h e eating disorder appears to relate to a c h i e v e m e n t a n d e x c e l l i n g i n another aspect o f their l i v e s . W h e n they c o u l d not a l w a y s a c h i e v e or e x c e l , the eating d i s o r d e r f u n c t i o n e d to meet that need. T h e same u n d e r l y i n g factors that p r o v i d e d the d r i v e for a c h i e v e m e n t p r o p e l l e d the eating disorder. A n d r e a articulates h o w her determination and focus to succeed relate to her eating d i s o r d e r as they also do to other areas o f her life. that was a goal that I was willing to do anything at all costs to meet.... It wasn't so much that I wanted to be skinny, or I wanted to be this, it's just that at all costs I was going to be successful at something and it didn't really matter how I had to get there...  A n d r e a also describes h o w her determination and focus i n other areas o f her life relate to e n g a g i n g i n her eating disorder b e h a v i o u r and mindset. When at those times in my life when um I sort of start to slip... I find those ... are the times of my biggest success.  121  Theme 7: Control and Restriction Control and restriction represents a prevalent theme throughout all of the participants' experience of Anorexia. The need for control, the associated feelings and reinforcement, feeling controlled by others, and also being controlled by the eating disorder itself are important aspects of control in the eating disorder experience. The sub-themes Quest for Personal Control, Controlled by Others, and Controlled and Consumed by the Eating Disorder relate specifically to the control dynamics that are present in the participants' experience of Anorexia. The sub-themes Restriction of Intake, Restriction of Emotions, and Restriction of Experience, further elaborate on participants' experience of control and restricting and the ways in which it exists in their lives and eating disorder experience. The Quest for Personal Control is a factor that is consistently described throughout all of the participants' experiences. This control-is often accompanied by feelings of power and satisfaction. Control as it relates to the eating disorder is often described as searching for the one thing that they felt that they could control when all other aspects of their lives felt out of control. Control of their body, weight and food intake represents a need for personal control, the basis of which resides outside of the eating disorder. The quest for personal control is also a response to the perceived control by others that they experience in their environments. Participants also experience conflict within themselves in their quest for control through their eating disorder, and describe the fight to regain control back from the eating disorder itself. Resistance to eating disorder treatment and interventions is another example of trying to maintain the feelings of control sought through the eating disorder. Grace describes her needs for control and how it relates to her eating disorder experience.  122  It was probably something I could control when I was just so scared that my life was  uncontrollable.  E m i l y articulates the force through which she attempted to prove to herself and others that she had control in her life. I was taking control myself I felt, and in a way ... nobody could take away from me, this was my area, I had control, and I was proving to the world that I had control over myself.  M a n y of the participants describe experiencing feelings of power, satisfaction, superiority and energy from the control they gained through their eating disorder. Grace describes how the eating disorder and control of her body made her feel superior to others. Because I could control myself, my hunger, my body, it made me feel superior to others.  Being Controlled by Others is another sub-theme related to control dynamics referred to as an aspect of the eating disorder experience for the participants. M a n y of the experiences of feeling controlled by others are responded to with anger, resentment, an increased need for control, or an increase in the eating disorder behaviour. Experiences of being forced to eat, gain weight or reduce or restrict activity levels are also frequently described as being controlled by others. Several of the participants actually comment on how  123  they needed to g i v e up c o n t r o l and to have others c o n t r o l t h e m and their e a t i n g to b e g i n to c h a l l e n g e their eating disorder and to attempt to m o v e b e y o n d it. T h e e x p e r i e n c e o f b e i n g C o n t r o l l e d and C o n s u m e d b y the E a t i n g D i s o r d e r is also present. T h e sense that the eating disorder was m o r e p o w e r f u l than they w e r e , or that it was an " u n s t o p p a b l e " force, h o l d i n g t h e m captive, was described. T h e r e is a sense that the eating d i s o r d e r w a s i n c o n t r o l a n d " c h o r e o g r a p h e d " every thought and b e h a v i o u r . A l t h o u g h the eating d i s o r d e r began for most o f the participants as a means t h r o u g h w h i c h they sought p e r s o n a l c o n t r o l , it then began to take c o n t r o l o f t h e m and their entire l i v e s .  The irony of  this r e l a t i o n s h i p is present i n m a n y o f the participants' c o n s c i o u s n e s s . T h e y r e c o g n i z e the i r o n y related to the " s o l u t i o n " then b e c o m i n g a p r o b l e m . A n d r e a describes the eating d i s o r d e r ' s c o n t r o l o f her b o d y and m i n d :  ...under that extreme starvation, and having it... for so long, I wasn 't able to decipher anything except that the eating disorder had run my body and my mind.  A frequent b e h a v i o u r and core sub-theme i n the participants' e x p e r i e n c e o f the eating disorder is R e s t r i c t i o n o f Intake. A s a l l o f the participants e x p e r i e n c e A n o r e x i a N e r v o s a , they describe s i g n i f i c a n t restrictive eating b e h a v i o u r , m a l n u t r i t i o n , a n d p h y s i c a l e m a c i a t i o n . T h e restriction o f intake a m o n g a l l participants, although v a r i a b l e , was t y p i c a l l y extreme and i n m a n y r e a c h e d l e v e l s o f minute-to-minute p r e o c c u p a t i o n and t a k i n g i n little or n o n o u r i s h m e n t . R e s t r i c t i o n o f intake seems to have begun as a diet or r e d u c t i o n o f f o o d i n t a k e and then progressed and escalated to starvation. M a n y participants related their restriction o f f o o d , their p r e o c c u p a t i o n s , and their eating d i s o r d e r e x p e r i e n c e s p e c i f i c a l l y w i t h R e s t r i c t i o n o f E m o t i o n s . P a r t i c i p a n t s a c t u a l l y  124  spent m u c h m o r e t i m e a n d energy d e s c r i b i n g their restriction o f e m o t i o n s t h r o u g h their eating d i s o r d e r e x p e r i e n c e rather than their s p e c i f i c eating disorder b e h a v i o u r s . A sense o f b e i n g v o i d o f any e m o t i o n s a n d n u m b n e s s w a s d e s c r i b e d . S e v e r a l participants also e x p l o r e d h o w e m o t i o n a l restriction a n d " s i l e n c e " i n their f a m i l y e n v i r o n m e n t s has i m p a c t e d t h e m . E m i l y describes a significant d i f f i c u l t y i n e x p e r i e n c i n g h e r e m o t i o n s . S h e speaks o f her e m o t i o n s as s o m e t h i n g she holds at arms length a n d l o o k s at rather than f e e l i n g t h e m . I've had such a struggle with letting myself feel my emotions.. .1 don't let myself feel my emotions.  A n d r e a relates h e r restriction o f her intake a n d eating d i s o r d e r e x p e r i e n c e to restriction o f her e m o t i o n s . Pulling away from my emotions I also pull away the physical need to eat and stuff like that. A l s o related to the theme o f restriction is the sub-theme, R e s t r i c t i o n o f E x p e r i e n c e , w h i c h is c o n c e p t u a l i z e d as restriction i n c o n n e c t i o n s w i t h others, i s o l a t i o n , a n d w i t h d r a w a l . F o r s o m e participants, their desire to w i t h d r a w a n d isolate w a s f a c i l i t a t e d b y their eating d i s o r d e r a n d f o r others restricted e x p e r i e n c i n g w a s a result o f their eating d i s o r d e r experience.  Theme 8: Awareness of Multifaceted Underlying Factors: Experience the Eating Disorder as Not Primarily Related to Food or Weight T h e participants are a l l c o g n i z a n t o f the c o m p l e x a n d m u l t i f a c e t e d u n d e r l y i n g factors that u n d e r l i e their eating disorder experience. A focus o n these factors is e m p h a s i z e d i n the  125  d e s c r i p t i o n s o f their e x p e r i e n c e o f A n o r e x i a rather than a focus o n s e e k i n g thinness or a p h y s i c a l i d e a l . T h e y o u n g w o m e n see past the presenting p r e o c c u p a t i o n s a n d b e h a v i o u r s associated w i t h f o o d and thinness, and s p e c i f i c a l l y address the existence o f c o m p l e x issues that u n d e r l i e their eating disorder. T h e m a j o r i t y o f the participants s p e c i f i c a l l y address their eating d i s o r d e r as not b e i n g about f o o d or w e i g h t .  T h e de-emphasis o n w e i g h t or f o o d issues is reflected i n the sub-  theme E x p e r i e n c e the E a t i n g D i s o r d e r as N o t A b o u t F o o d or W e i g h t . T h e participants are aware o f the c o n t r a d i c t i o n between their b e h a v i o u r and the u n d e r l y i n g c o n t r i b u t i n g factors. Participants identify that they i n fact d i d not want to be t h i n and were distressed b y t h e i r p h y s i c a l state and e m a c i a t i o n . In one instance, a focus o n p h y s i c a l attractiveness a n d thinness created a s i g n i f i c a n t l e v e l o f dissonance and distress w i t h i n the i n d i v i d u a l as she sought to satisfy m u c h m o r e existential and deep felt needs.  Theme 9: Sacrifice, Defiance a n d Separation: O f Self, of B o d y , a n d of Needs F o r the participants, the experience o f an eating d i s o r d e r is c o n c e p t u a l i z e d as a sacrifice o f b o d y , o f self, and o f personal needs, b y p r i o r i t i z i n g and m e e t i n g those o f others before their o w n . -f-In m a n y w a y s , the eating disorder is a defiance o f the p h y s i c a l b o d y a n d its needs, as w e l l as a defiance o f e n v i r o n m e n t a l forces.  Issues related to i d e n t i t y are part o f  the eating d i s o r d e r experience. Participants often s a c r i f i c e d their sense o f self or i d e n t i t y t h r o u g h their struggle. T h e y refer to both d e f i n i n g themselves t h r o u g h the eating disorder, and also attempting to separate it f r o m themselves. T h i s can o c c u r s i m u l t a n e o u s l y as the  /  •  126  y o u n g w o m e n struggle to f i n d w h i c h parts o f their personalities and life are t r u l y their o w n , and w h i c h other elements o f their experience are created b y A n o r e x i a . S a c r i f i c e is a sub-theme e x p l o r e d throughout the eating d i s o r d e r e x p e r i e n c e . P a r t i c i p a n t s refer to a sacrifice o f themselves, their needs, and their b o d i e s for v a r i o u s purposes. In s o m e o f the y o u n g w o m e n sacrifice is reflected i n a p r i o r i t i z a t i o n o f the needs o f those c l o s e to t h e m , w h i l e i n others the needs o f the larger c o m m u n i t y or the p e o p l e o f the w o r l d are p r i o r i t i z e d . A p r e d o m i n a t e sub-theme i n the participants' l i v e s p r i o r to the eating d i s o r d e r e x p e r i e n c e , as w e l l as throughout the experience is the P r i o r i t i z a t i o n o f the N e e d s o f O t h e r s . T h e y o u n g w o m e n also experience a heightened awareness and s e n s i t i v i t y to the needs o f others w h i c h appears to relate to p r i o r i t i z a t i o n o f other's needs and f e e l i n g r e s p o n s i b l e f o r those needs. S o m e o f the participants appear to have felt that they d i d not deserve to meet their o w n needs, o r to have their needs met b y others. T h e y o u n g w o m e n often i n t e r n a l i z e d a n d m i r r o r e d the e m o t i o n a l states o f others, p r o v i d i n g what others needed f r o m t h e m i n the m o m e n t , w h i l e s a c r i f i c i n g their o w n needs at that t i m e . S e v e r a l participants also describe a w i l l i n g n e s s and m o t i v a t i o n to recover f r o m their eating disorder for others rather than for themselves, another e x a m p l e o f p r i o r i t i z i n g the need o f others o v e r their o w n . E m i l y describes her s e n s i t i v i t y to, and p r i o r i t i z a t i o n of, the needs o f those a r o u n d her:  I could tell if my mum was sad, and I would try and push away my own needs, even when I was very small.  E s p r i t describes her m o t i v a t i o n to r e c o v e r for others' aside f r o m herself:  "If I can't eat for me then at least I can eat for the world".  127  D e f i a n c e and D e n i a l are consistently d e s c r i b e d throughout the p a r t i c i p a n t s ' e x p e r i e n c e o f A n o r e x i a . D e f i a n c e and d e n i a l o f needs, and also the eating d i s o r d e r as an act o f defiance is d e s c r i b e d . Participants speak o f d e n y i n g their b o d i l y needs, their b o d y itself, death, and the severity or health r i s k related to their eating disorder. T h e eating d i s o r d e r as an act o f defiance is often a response to a f e e l i n g o f b e i n g c o n t r o l l e d , or d e f y i n g others i n the o n l y w a y that they felt that they c o u l d . S e v e r a l participants see their eating d i s o r d e r as an act o f defiance a t y p i c a l o f adolescent presentation. Rather than a c t i n g out i n an overt s h o w o f defiance, they are i n t e r n a l i z i n g and d e f y i n g through the use o f their o w n b o d y a n d starvation. A n d r e a describes her eating disorder as an act o f defiance:  / knew that what I was playing with was dangerous but I still did it anyway. Sort of like a, I guess an act of defiance.  S e p a r a t i o n and D i s s o c i a t i o n are also related to the eating d i s o r d e r e x p e r i e n c e for m a n y o f the participants. Participants sought to experience themselves as outside o f their life or c o n s c i o u s n e s s , or feel that w a y as a result o f their eating disorder. T h e r e was a sense that the p h y s i c a l a n d p s y c h i c realms can be separated. T h i s d i s s o c i a t e d or separated state was d e s c r i b e d as either a g o a l or consequence o f the eating disorder. A n d r e a also articulates h o w her eating disorder a l l o w e d her to dissociate a n d separated h e r s e l f f r o m her b o d y and other elements o f her w o r l d .  / didn 'tfeel, I just kind of wanted to get away from everything and, just kind of separate myself from the physical world I guess.  128  I felt like I was carrying the weight of the world and I thought that if you could defy everything and separate mind from body then I wouldn 't have to deal with it anymore.  D e f i n i n g o f S e l f i s a sub-theme that reflects the participants' e x p e r i e n c e o f d e f i n i n g themselves t h r o u g h h a v i n g an eating disorder o r b e i n g unable to separate themselves f r o m it. A n d r e a c l e a r l y expresses h o w she defines herself b y her eating disorder: I think about it and I think well eventually you kind of become defined by it and you realize well if I don't have that then who am I kind of thing. And it's something that I'd like to get rid of but, like, I don't know, I think for me there never really will be a full recovery but I'm willing to live with that, so, yeah.  E s p r i t describes h o w she struggles w i t h seeing h e r s e l f as separate f r o m her eating disorder, a n d also considers h o w she is defined b y it: On one hand I can so do this, I have had a lot more difficult things in my life and it's no problem but on the other hand what if the disease is stronger than me. Whatever me is and whatever the disease is and however the two go together.  A l t h o u g h participants m a y define themselves, o r parts o f themselves, t h r o u g h their eating disorder, they also refer to e x t e r n a l i z i n g their eating disorder f r o m themselves a n d several refer s p e c i f i c a l l y to an "eating disorder v o i c e " . T h e sub-theme, E x p e r i e n c e o f E a t i n g D i s o r d e r V o i c e - E x t e r n a l i z a t i o n o f E a t i n g D i s o r d e r , reflects the participants' e x p e r i e n c e o f e x t e r n a l i z i n g the eating disorder f r o m themselves a n d reference to their eating d i s o r d e r v o i c e .  129  T h e v o i c e is o n l y a c o n c e p t u a l i z a t i o n and does not reflect an actual v o i c e that they hear c o n c r e t e l y . It is often the w a y that the y o u n g w o m e n t h i n k o f the e x t e r n a l i z e d representation o f their eating d i s o r d e r and the " t w o parts" o f their selves. T h e eating disorder v o i c e is seen as p o w e r f u l and often m a l i c i o u s , destructive and m a n i p u l a t i v e . P h o e n i x attempt to describe her eating disorder v o i c e :  I don't know how to describe it. It's like... it's not like a schizophrenic kin  actual voice that you hear, it's more like a thought but it's in, it's not alw in words, it's kind ofjust a feeling...but it's still, it's kind of words and it's  kind of not... but it's always there. It's like there's two parts to me, that's what it was like.  Theme 10: Appreciated, Purposeful, and Meaningful Experience In a d d i t i o n to the o v e r w h e l m i n g negative and p a i n f u l experiences associated w i t h the e x p e r i e n c e o f A n o r e x i a d e s c r i b e d b y the participants, they also reflect o n an a p p r e c i a t i o n a n d r e c o g n i t i o n o f the v a l u e o f the eating disorder i n their l i v e s . A l l participants e m p h a s i z e the purpose and m e a n i n g associated w i t h the eating disorder experience. A l t h o u g h not an e x p e r i e n c e that they w o u l d ever w i s h someone else to go through, it is one that m a n y w o u l d not erase f r o m their l i v e s i f g i v e n the opportunity. A n d r e a reflects o n her experience o f her eating disorder h a v i n g purpose and m e a n i n g i n this excerpt and h o w although it is an experience she w o u l d not w i s h o n s o m e o n e else, it is one that she feels that she needed to go through i n order to recreate herself.  Andrea: ... it was something that, it's like an awful thing to go through bu wouldn 't take it back for anything, ...I learned a lot about myself and  130  continue to learn... I definitely wouldn 't wish anything that I've done to myself on anyone else. Alison: But it's something that you wouldn't take back for your own experience? Andrea: Definitely. Alison: mmm. Can you tell me more about this?... Andea: I guess, the theory of, you need to self-destruct before you can excel. I always found that like, oh I don't know it makes sense in my head, uh, that, I don't know I just found that like it was almost the way that I had recreated myself. Like I've gone through that and come out kind of, I don't know,  better. Still struggling but, it just kind of like, I don't know, I just kind of cam out as an individual, not really caring about things, not really getting caught up in the things that I always found so important, like people my age ...  T h e sub-theme A p p r e c i a t i o n and R e c o g n i t i o n o f the V a l u e o f the E a t i n g D i s o r d e r E x p e r i e n c e is important to the experience o f an eating disorder a m o n g a l l the participants. T h e eating d i s o r d e r has brought struggle and g r i e f to the l i v e s o f the y o u n g w o m e n , but there is also a sense that it has p r o v i d e d t h e m w i t h an o p p o r t u n i t y to learn about t h e m s e l v e s , or has p r o v i d e self-understanding and strength. T h e eating disorder is appreciated and met w i t h a sense o f v a l u e , gratitude, and o f h a v i n g been w o r t h w h i l e . M a r y c o m m e n t s o n the strength she g a i n e d through the e x p e r i e n c e o f her e a t i n g disorder:  "if it doesn 't kill you it makes you stronger! Almost literally."  131  P h o e n i x c o n c e p t u a l i z e s a n d appreciates her eating disorder as a light: I felt like I was on this road and there was this end there was this light at the end that would make things clearer.  G r a c e e x p l o r e s h o w her eating disorder experience caused her to learn things as an adolescent that m a n y adults m a y not have learned: That's kind of a weird thing, it was like a living hell for a whole year but coming out the other end of it I've learned so much ... Just to have been able to have like a train wreck stop that and everything and be able to decide how I wanted to live my life it was really valuable.  P u r p o s e a n d M e a n i n g i n the eating disorder experience i s an important sub-theme that also relates to the a p p r e c i a t i o n o f the value o f the eating disorder e x p e r i e n c e . P a r t i c i p a n t s e x p l i c i t l y refer to f e e l i n g that their eating disorder experience w a s p u r p o s e f u l , h a d m e a n i n g i n their l i v e s , a n d w a s s o m e t h i n g that they needed to g o through. T h e y o u n g w o m e n often e x p l o r e the purpose a n d m e a n i n g , as they attempt to m a k e sense o f the e x p e r i e n c e o f the eating d i s o r d e r i n their l i v e s . P h o e n i x often referred to her understanding o f the purpose a n d m e a n i n g o f her eating disorder. S h e c l e a r l y indicates that i n f i n d i n g a n d a c c e p t i n g the purpose o f her eating disorder she e x p e r i e n c e d m o r e freedom f r o m it.  132  I think, again it was like most other people happened due to a cause and mine was for a purpose... this was meant to happen, it just didn't happen, it was meant to happen.  it didn't happen so much from a cause as for a purpose.. .a person's mind like, it can either be, it can be stuffed with things that don't really mean anything, just a bunch of surface things but then with the eating disorder it kind of cleared it all. It was like whoa, I can see now. Just see everything in a total different light.  E a t i n g D i s o r d e r as a M e t a p h o r is a sub-theme that reflects the w a y i n w h i c h several o f the participants c o n c e p t u a l i z e their eating disorder as a metaphor f o r s o m e t h i n g else. E m i l y describes h o w her eating disorder w a s not about thinness but w a s a m e t a p h o r for her desire to take up less space i n the w o r l d :  it's not really about my body at all, even when I was most sick, and depriving myself of food, it wasn 't because I wanted to be thinner, it was because I wanted to take up less space, I wanted to be less... in the way,... less a bother. And the only way to do that would be to take up less space in the world.  A n d r e a e x a m i n e s h o w her eating disorder represents a c o l d n e s s o f m i n d , b o d y a n d spirit.  I'd say that when I was in I guess peak starvation I was very cold, urn emotionally and spiritually and physically.  133  T h e sub-theme S e a r c h i n g relates to h o w m a y o f the participants w e r e s e a r c h i n g for s o m e t h i n g t h r o u g h their experience o f an eating disorder. T h e search is seen as a j o u r n e y towards s o m e t h i n g . S o m e t i m e s they f o u n d what they w e r e s e a r c h i n g for; i n other instances it continues to elude t h e m .  134  CHAPTER V Discussion  T h i s study describes the core and c o m m o n themes o f the e x p e r i e n c e o f an eating d i s o r d e r a m o n g s i x gifted female adolescent participants, u s i n g data g a i n e d through i n - d e p t h p h e n o m e n o l o g i c a l i n t e r v i e w s . A situated structure was d e v e l o p e d for each i n d i v i d u a l participant, based o n the p r e d o m i n a n t themes i n their personal experience. T e n m a i n themes e m e r g e d f r o m the data w h i c h i n c l u d e d : 1) N e g a t i v e A f f e c t and S e l f - P e r c e p t i o n s , E m o t i o n a l P a i n , and D e t e r i o r a t i o n , 2) O v e r w h e l m e d and C o n f l i c t e d , 3) N o t F i t t i n g : I n c o n g r u e n c e and A w a r e n e s s o f D i f f e r e n c e s , 4) C o p i n g T h r o u g h E n g a g i n g i n the E a t i n g D i s o r d e r , 5) E x p e r i e n c e o f Giftedness and E a t i n g D i s o r d e r and/or Struggle E x p l i c i t l y C o n n e c t e d , 6) P e r f e c t i o n i s m - S t r i v i n g to A t t a i n "Perfect", 7) C o n t r o l and R e s t r i c t i o n , 8) A w a r e n e s s o f M u l t i f a c e t e d U n d e r l y i n g Factors, 9) S a c r i f i c e , D e f i a n c e and Separation: O f S e l f , o f B o d y , and o f N e e d s , 10) A p p r e c i a t e d , P u r p o s e f u l and M e a n i n g f u l . In this chapter, the s i g n i f i c a n c e o f the f i n d i n g s w i l l be e x p l o r e d i n l i g h t o f the literature r e v i e w e d and the m e t h o d o l o g y u t i l i z e d , and w i l l also be d i s c u s s e d i n terms o f gifted y o u n g w o m e n and adolescents w h o m a y experience eating disorders. T h i s d i s c u s s i o n w i l l also address what i m p l i c a t i o n s the study m a y have for future research, p s y c h o e d u c a t i o n , and psychotherapeutic practice. T h e subjective e x p e r i e n c i n g o f the researcher is also c o n s i d e r e d , a l o n g w i t h n o t e w o r t h y observations about the s a m p l e and f i n d i n g s .  Significance of Findings in Light of Previous  Research  A d i s c u s s i o n o f the f i n d i n g s as they relate to p r e v i o u s research is c h a l l e n g i n g for this study. A s m e n t i o n e d p r e v i o u s l y , although s p e c i f i c literature p e r t a i n i n g to gifted i n d i v i d u a l s  135  w h o e x p e r i e n c e eating disorders is sparse, the literature i n each o f the fields o f giftedness and eating disorders is vast. F o r the purposes o f this d i s c u s s i o n , some o f the general t o p i c s addressed i n the literature r e v i e w w i l l be e x p l o r e d c o n c i s e l y , w h i l e m o r e s p e c i f i c attention w i l l be p a i d to areas i n w h i c h the current research f i n d i n g s d i r e c t l y relate to literature r e v i e w e d . T h e p r i m a r y focus w i l l be on p r e v i o u s literature s p e c i f i c to eating disorders a m o n g gifted adolescents.  Conceptualisations  of Giftedness  T h e fact that the participants e x p l i c i t l y related their eating d i s o r d e r e x p e r i e n c e to aspects o f b e i n g gifted is o f particular interest. W i t h o u t b e i n g p r o m p t e d , the participants d i s c u s s e d their giftedness, its association w i t h their eating disorder, and the s p e c i f i c aspects o f giftedness that create p a i n and struggle i n their l i v e s . B y virtue o f b e i n g aware o f the purpose a n d participant selection c r i t e r i a o f the study, participants m a y h a v e been m o r e c o g n i z a n t o f the r e l a t i o n s h i p between giftedness and eating disorders. T h e y o u n g w o m e n appeared to have h a d v a r y i n g l e v e l s o f experience i n d i s c u s s i n g their giftedness as it relates to their eating disorder. S o m e seemed to see giftedness as a d e f i n i n g characteristic i n their l i v e s and eating disorder experience, and m o r e o f a w a y o f b e i n g i n the w o r l d than a trait. F o r other participants, c o n s i d e r i n g h o w giftedness related to their eating d i s o r d e r appeared to have been m o r e o f a n e w venture. Giftedness as a construct is difficult to define concretely. T h e literature r e v i e w e m p h a s i z e s this point, and p r o v i d e d a b r i e f sample o f s o m e o f the current c o n c e p t u a l i z a t i o n s o f giftedness. P a r t i c u l a r l y salient i n the experience o f some o f the participants, and i n the w a y they related their o w n experience o f giftedness to their eating disorder, are the interpersonal, intrapersonal and existential intelligences as c o n c e p t u a l i z e d b y V o n K a r o l y i ,  136  R a m o s - F o r d and G a r d n e r (2003). T h e y o u n g w o m e n d o not t y p i c a l l y speak o f their c o g n i t i v e i n t e l l i g e n c e , or a c a d e m i c a b i l i t y , but p l a c e m o r e emphasis o n their k e e n l y attuned interpersonal and intrapersonal abilities w h e n d i s c u s s i n g their giftedness. V o n K a r o l y i , R a m o s - F o r d and G a r d n e r have d e s c r i b e d a n i n t h , as yet u n c o n f i r m e d , e x i s t e n t i a l i n t e l l i g e n c e as i n v o l v i n g "an interest and c o n c e r n w i t h ultimate issues" and " p o n d e r i n g the fundamental questions o f e x i s t e n c e " (p. 102). F e e l i n g the " w e i g h t o f the w o r l d " , e x i s t e n t i a l q u e s t i o n i n g , a n d e x p e r i e n c i n g e m o t i o n a l p a i n f r o m their e n v i r o n m e n t , was a s i m i l a r theme apparent i n m a n y o f the y o u n g w o m e n ' s descriptions o f their eating disorder e x p e r i e n c e . H e i g h t e n e d sensitivities and awareness referred to as p s y c h i c o v e r e x c i t a b i l i t i e s are d i s c u s s e d b y m a n y theorists and researchers i n the f i e l d o f giftedness (e.g. A c k e r m a n & P a u l u s , 1997; B o u c h e t & F a l k , 2 0 0 1 ; J a c k s o n , 1995; J a c k s o n & Peterson, 2 0 0 3 ; S c h u l t z & D e l i s l e , 2 0 0 3 ; S i l v e r m a n , 1994, 1998; P i e c h o w s k i , 1997, 2 0 0 3 ) . T h e E x p e r i e n c e o f Giftedness and E a t i n g D i s o r d e r and/or S t r u g g l e E x p l i c i t l y C o n n e c t e d theme, a n d the subtheme H e i g h t e n e d A w a r e n e s s / S e n s i t i v i t y relate to p s y c h i c o v e r e x c i t a b i l i t i e s . J a c k s o n and Peterson (2003) address the relationship between o v e r e x c i t a b i l i t i e s and p s y c h o l o g i c a l distress a m o n g gifted adolescents, as w e l l as h o w v a r i o u s traits contribute to gifted adolescents' feelings o f b e i n g "out o f s y n c " or "at odds w i t h their v a r i o u s c o n t e x t s " (p. 177). T h i s sense o f not fitting i n , or b e i n g at odds w i t h v a r i o u s contexts was c l e a r l y d e s c r i b e d i n the theme N o t F i t t i n g : Incongruence and A w a r e n e s s o f D i f f e r e n c e s . It also relates to the C o p i n g T h r o u g h E n g a g i n g i n the E a t i n g D i s o r d e r theme, as m a n y o f the participants d e s c r i b e c o p i n g w i t h elements o f their giftedness, and feelings o f i n c o n g r u e n c e through their e a t i n g disorder.  137  Specific Literature Related to Eating Disorders Among Gifted  Adolescents  A s p r e v i o u s l y m e n t i o n e d , the s p e c i f i c literature related to eating disorders a m o n g adolescents is c u r r e n t l y not w e l l d e v e l o p e d . T h i s study contributes m u c h to the f i e l d o f giftedness, as it s p e c i f i c a l l y e x a m i n e s an area that is a l l u d e d to as important, or i n n e e d o f e x p l o r a t i o n b y a n u m b e r o f r e c o g n i z e d experts (i.e. G a t t o - W a l d o n , 1999; J a c k s o n & Peterson, 2 0 0 3 ; Peterson, 1998; G a r n e r , 1991). T h e literature that is s p e c i f i c to characteristics o f gifted i n d i v i d u a l s w h o experience eating disorders can n o w be e x a m i n e d i n l i g h t o f the f i n d i n g s o f this study. S p e c i f i c a l l y , several o f the themes that e m e r g e d relate to characteristics o f giftedness that theorists and researchers often related to e a t i n g d i s o r d e r r i s k factors, s u c h as p e r f e c t i o n i s m , determination to achieve, s e n s i t i v i t y , p r i o r i t i z a t i o n o f the needs o f others, and l o w self-esteem. S i l v e r m a n (1994), K e r r (2000) and K e r r and N i c p o n (2003) b r i e f l y m e n t i o n the societal pressures o n gifted adolescent females to meet s o c i a l expectations o f beauty and attractiveness. T h e y suggest that gifted adolescents m a y be p a r t i c u l a r l y adept at p i c k i n g u p o n s o c i e t a l expectations and pressures related to thinness, w e i g h t and appearance p r e o c c u p a t i o n , and m a y therefore be m o r e at r i s k for eating disorders. C o n t r a r y to these ideas, the gifted adolescents i n this study, for the most part, neglected d e s c r i p t i o n s o f s o c i e t a l pressures or a search for p h y s i c a l ideals or thinness i n d e s c r i b i n g their eating d i s o r d e r e x p e r i e n c e . T h e y o u n g w o m e n instead e x p l i c i t l y p o i n t out that their eating d i s o r d e r e x p e r i e n c e w a s not about these factors, as has been addressed i n the sub-theme E x p e r i e n c e E a t i n g D i s o r d e r as N o t A b o u t F o o d or W e i g h t . In m a n y o f the cases w h e r e the e a t i n g d i s o r d e r d i d relate to a search for a p h y s i c a l i d e a l , it was a c k n o w l e d g e d that this created a f e e l i n g o f dissonance, as it was not i n k e e p i n g w i t h their c o n s c i o u s values and depth o f  138  e x p e r i e n c i n g . O n e participant appeared v e r y susceptible to societal messages, and f o c u s e d m u c h attention o n her search for a p h y s i c a l i d e a l , but this characteristic was inconsistent w i t h the m a j o r i t y o f the data. S i l v e r m a n (1999) b r i e f l y alludes to a relationship between giftedness, p e r f e c t i o n i s m a n d a p o s s i b l e p r e d i s p o s i t i o n to eating disorders a m o n g gifted adolescents. G a t t o - W a l d e n (1999), G a r n e r (1991), and L e r o u x and C u f f a r o (2001) a l l e m p h a s i z e p e r f e c t i o n i s m as a factor related to eating disorders a m o n g gifted or h i g h l y a c a d e m i c a l l y able adolescent females. T h e p e r v a s i v e p e r f e c t i o n i s m i n v o l v e d i n the eating d i s o r d e r e x p e r i e n c e a m o n g these gifted y o u n g w o m e n is o u t l i n e d i n the theme, P e r f e c t i o n i s m - S t r i v i n g to A t t a i n "Perfect", and was e m p h a s i z e d b y a l l participants as an important c o m p o n e n t o f the e x p e r i e n c e o f A n o r e x i a . Sub-themes o f the P e r f e c t i o n i s m theme i n c l u d e : a G o a l o f "Perfect A n o r e x i a " , E x p e c t a t i o n ( o f self and others), D e t e r m i n a t i o n and F o c u s . G a r n e r (1991) identifies m a n y r i s k factors for eating disorders that m a y relate to gifted adolescents' experience. H e d e s c r i b e d p o s s i b l e factors i n f l u e n c i n g the d e v e l o p m e n t o f d i s o r d e r e d eating a m o n g gifted adolescents such as c o m p e t i t i v e settings, a n d treating w e i g h t loss as "another area for d i s p l a y i n g personal c o m p e t e n c e " (p. 53). T h e s e p r e d i s p o s i n g factors refer p r i m a r i l y to the participants' experience o f A n o r e x i a d e s c r i b e d i n the P e r f e c t i o n i s m theme. W h i l e the participants do not s p e c i f i c a l l y refer to c o m p e t i t i v e n e s s or c o m p e t i t i v e settings, determination and focus, and a quest to a c h i e v e and e x c e l w e r e aspects o f the eating disorder experience for the participants. A quest for "Perfect A n o r e x i a " met a c h i e v e m e n t needs w h e n the participants felt inadequate i n others areas o f their l i v e s . T h e i r eating d i s o r d e r as an area to d i s p l a y "personal c o m p e t e n c e " is d e s c r i b e d m o r e c o m p l e t e l y i n the sub theme, G o a l o f "Perfect A n o r e x i a " . G a r n e r also identifies l o w self-esteem as another  139  p r e d i s p o s i n g factor that m a y p l a c e gifted adolescents at r i s k for an eating disorder. T h i s emerges i n the sub-theme, F e e l i n g s o f W o r t h l e s s n e s s , L o w S e l f - E s t e e m a n d C r i t i c a l o f Self, and is related to the l o w self esteem r i s k factor noted b y G a r n e r (1991). O v e r a l l , the r i s k factors suggested b y G a r n e r represent a select sub-section o f the e x p e r i e n c e o f an e a t i n g d i s o r d e r a m o n g the participants i n this study. O n e theme ( P e r f e c t i o n i s m ) , its sub-themes, a n d one a d d i t i o n a l sub-theme (Worthlessness, L o w S e l f - E s t e e m and C r i t i c a l o f Self) a c c o u n t for the m a j o r i t y o f factors c i t e d b y G a r n e r . B a s e d o n c l i n i c a l experience and anecdotal e v i d e n c e , G a t t o - W a l d e n (1999) suggests that a m o n g her gifted clients s t r u g g l i n g w i t h disordered eating, several characteristics are c o m m o n . T h e s e characteristics i n c l u d e a " p e r s o n a l identity that has d i s o w n e d b e i n g gifted, d e b i l i t a t i n g p e r f e c t i o n i s m , e x c e s s i v e need to please others, experience o f i s o l a t i o n and l o n e l i n e s s , stressful transition d u r i n g the onset o f the disorder and f a m i l y d y n a m i c s w h i c h m a y i n c l u d e : o v e r p r o t e c t i o n , enmeshment, perfectionistic f a m i l y standards and abuse or a d d i c t i v e b e h a v i o r " (p. 119). S e v e r a l o f the characteristics that G a t t o - W a l d e n refers to w e r e present i n these f i n d i n g s i n s o m e w a y , although several characteristics that were n o t e d b y G a t t o - W a l d e n were not f o u n d i n the current study. T h e " e x c e s s i v e n e e d to please others" noted b y G a t t o - W a l d e n m a y be reflected i n the sub-themes, E x p e c t a t i o n s , and P r i o r i t i z a t i o n o f N e e d s o f Others. H e r e participants describe not so m u c h a need to please as a heightened awareness, i n t e r n a l i z a t i o n , and p r i o r i t i z a t i o n o f the needs o f others. G a t t o - W a l d e n notes " i s o l a t i o n and l o n e l i n e s s " as often b e i n g e x p e r i e n c e d b y gifted clients w i t h eating disorders, and this is congruent w i t h the sub-theme, R e s t r i c t i o n o f E x p e r i e n c e - W i t h d r a w a l a n d I s o l a t i o n . G a t t o - W a l d e n also l i n k s stressful transitions at onset and s p e c i f i c f a m i l y factors to the e x p e r i e n c e o f an eating disorder a m o n g gifted clients. N o stressful transitions were  140  e m p h a s i z e d , and the f a m i l y characteristic, "perfectionistic standards" is the o n l y factor w h i c h is related to i n the f i n d i n g s o f the current study. C o n t r a r y to G a t t o - W a l d e n ' s inference that gifted clients w h o experience eating disorders have " d i s o w n e d b e i n g g i f t e d " , the m a j o r i t y o f the participants i n this study s p e c i f i c a l l y a c k n o w l e d g e d their giftedness, a n d related m a n y gifted q u a l i t i e s to their experience o f an eating disorder. In some w a y s G a t t o - W a l d e n (1999) has d e s c r i b e d characteristics or factors that were present i n the current f i n d i n g s . O n the w h o l e , h o w e v e r , I f i n d s i g n i f i c a n t differences i n the essence o f the e m o t i o n a l t u r m o i l , the w a y s that giftedness m a y relate to the experience, or h o w the eating d i s o r d e r a l l o w s y o u n g w o m e n to c o p e w i t h elements o f their experience. T h e factors that G a t t o - W a l d e n suggests are central factors related to eating disorders a m o n g gifted clients c a n be a c c o u n t e d f o r b y a sub-section o f the current research f i n d i n g s . D e s p i t e the weakness o f the sources o n w h i c h L e r o u x and C u f f a r o (2001) suggest factors that o v e r l a p h i g h a c a d e m i c a b i l i t y and eating disorders, several c o r r e s p o n d i n s o m e w a y to the current research f i n d i n g s . L e r o u x and C u f f a r o cite h y p e r s e n s i t i v i t y , w h i c h m a y be s i m i l a r to the H e i g h t e n e d A w a r e n e s s / S e n s i t i v i t y sub-theme, persistence, c o m p e t i t i v e n e s s and h i g h a c h i e v e m e n t c o r r e s p o n d i n g to the D e t e r m i n a t i o n and F o c u s sub-theme, and p e r f e c t i o n i s m c l e a r l y c o r r e s p o n d i n g to the P e r f e c t i o n i s m theme. H a v i n g an i n t r o s p e c t i v e a n d i n t u i t i v e nature, intensity, and e x c i t a b i l i t y m a y c o r r e s p o n d to the E x p e r i e n c e o f G i f t e d n e s s and E a t i n g D i s o r d e r E x p l i c i t l y C o n n e c t e d theme and/or the H e i g h t e n e d A w a r e n e s s / S e n s i t i v i t y sub-theme, and f i n a l l y conscientiousness c o u l d be seen as s i m i l a r to the P r i o r i t i z a t i o n o f the N e e d s o f Others sub-theme. Factors seen as o v e r l a p p i n g m e n t i o n e d b y L e r o u x a n d C u f f a r o that were not i n d i c a t e d i n the research f i n d i n g s i n c l u d e :  141  i m p u l s i v e n e s s , h i g h I Q , a c a d e m i c e x c e l l e n c e , p r e c o c i o u s b e h a v i o u r s , and h y p e r m a t u r i t y (p. 113).  Societal Pressures, Self-Esteem, Perfectionism and Personality  Factors  P r i o r to c o n d u c t i n g this study, the i n f l u e n c e o f s o c i a l pressures, self-esteem v a r i a b l e s , and p e r f e c t i o n i s m were a l l suggested as factors that c l e a r l y intersected research i n b o t h the giftedness a n d eating d i s o r d e r fields. P e r s o n a l i t y and risk factors e x a m i n e d i n literature p e r t a i n i n g to eating disorders a m o n g adolescents were also b r i e f l y e x p l o r e d . E a c h o f these areas c a n be b r i e f l y i l l u m i n a t e d through the f i n d i n g s o f the current study. T h e effect o f societal pressures related to thinness, beauty and i m a g e s o f f e m i n i n i t y o n d i s o r d e r e d eating a m o n g adolescents is addressed i n both gifted and eating d i s o r d e r literatures (e.g. K e r r , 2 0 0 0 ; Sands & H o w a r d - H a m i l t o n , 1995; S i l v e r m a n , 1994; Slater, G u t h r i e s & B o y d , 2 0 0 1 ) . T h e s u s c e p t i b i l i t y and r i s k that is associated w i t h eating disorders a m o n g b o t h gifted and non-gifted adolescent p o p u l a t i o n s are e x p l o r e d i n current literature. A s p r e v i o u s l y m e n t i o n e d , this aspect o f the eating disorder e x p e r i e n c e d i d not t y p i c a l l y emerge t h r o u g h the research f i n d i n g s . W h a t d i d emerge through the f i n d i n g s w e r e the theme, A w a r e n e s s o f M u l t i f a c e t e d U n d e r l y i n g Factors, and the sub-theme, E x p e r i e n c e o f E a t i n g D i s o r d e r N o t A b o u t F o o d or W e i g h t . Participants s p e c i f i c a l l y referred to c o m p l e x u n d e r l y i n g factors, m a n y o f w h i c h relate to other themes. A de-emphasis o n thinness, and f e e l i n g p e r s o n a l distress as a result o f p h y s i c a l deterioration and e m a c i a t i o n was present i n the e x p e r i e n c e o f m a n y participants. In one instance a participant i d e n t i f i e d a p r e o c c u p a t i o n w i t h her appearance.  T h i s remains an inconsistent aspect o f the data as a w h o l e . A n o t h e r  participant d i s c u s s e d her v u l n e r a b i l i t y to societal messages, but was o v e r t l y distressed a n d  142  e x p e r i e n c e d c o n f l i c t w i t h i n herself as a result o f the i n c o n g r u e n c e b e t w e e n that focus a n d her p e r s o n a l values and depth. M u c h o f the literature r e v i e w e d p e r t a i n i n g to self-esteem or self-concept v a r i a b l e s a m o n g gifted adolescents contains c o n t r o v e r s i a l f i n d i n g s (e.g. G a l l a g h e r 2 0 0 3 ; H o g e & R e n z u l l i 1993; L e a - W o o d & C l u n i e s - R o s s , 1995; N i e h a r t , 1999). W h e t h e r gifted students e x p e r i e n c e h i g h e r or l o w e r levels o f self-esteem, or m o r e p o s i t i v e or negative self-concept, appears to relate to the measures used, the w a y s i n w h i c h the constructs are o p e r a t i o n a l i z e d , and whether s o c i a l and a c a d e m i c self-concept is differentiated. L i t e r a t u r e that addresses eating disorders a m o n g adolescents t y p i c a l l y cites l o w - s e l f esteem as a r i s k factor (e.g. G u a l , et a l . , 2 0 0 2 ; M u s s e l l , B i n f o r d & F u l k e r s o n , 2 0 0 0 ) . M u s s e l l , B i n f o r d and F u l k e r s o n (2000) also suggest that negative self-evaluation and p e r c e i v e d ineffectiveness are also r i s k factors. T h e f i n d i n g s f r o m this study relate to this area i n t w o w a y s . First, the sub-theme W o r t h l e s s n e s s , L o w - E s t e e m , and C r i t i c a l o f S e l f c l e a r l y illustrates the p a r t i c i p a n t s ' e m o t i o n a l p a i n , their negative feelings about themselves, and d e v a l u a t i o n o f their o w n w o r t h . S e c o n d l y , w i t h i n the theme C o n t r o l and R e s t r i c t i o n , participants describe d e r i v i n g feelings o f satisfaction, p o w e r , and superiority f r o m their p e r s o n a l quest for c o n t r o l associated w i t h their eating disorder. F r o m this perspective, the experience o f an eating d i s o r d e r m a y be seen as a means t h r o u g h w h i c h the y o u n g w o m e n compensate for l o w self-esteem a n d negative selfconcept. P e r f e c t i o n i s m is the m o s t consistently m e n t i o n e d factor associated w i t h b o t h e a t i n g disorders and giftedness. T h e literature r e v i e w e d consistently cites p e r f e c t i o n i s t i c tendencies or p e r f e c t i o n i s m as a r i s k or personality factor a m o n g i n d i v i d u a l s w h o e x p e r i e n c e eating disorders (e.g. A s h b y & R o t t m a n , 1998; B a s t i a n i , R a o , W e l t z i n , & K a y e , 1995; G u a l , et a l . ,  143  2 0 0 2 ; M c V e y , P e p l a r , D a v i s , Flett, & A b d o l e l l , 2 0 0 2 ; Shafran & M a n s e l l , 2 0 0 1 ) . W i t h i n gifted literature a c o n t r o v e r s y exists as to whether p e r f e c t i o n i s m a m o n g gifted i n d i v i d u a l s contributes to maladjustment. F e w theorists disagree that p e r f e c t i o n i s m is often a characteristic o f gifted i n d i v i d u a l s (e.g. G r e e n s p a n , 2 0 0 0 ; N u g e n t , 2 0 0 0 ; S c h u l e r , 2 0 0 0 ; S i l v e r m a n ; 1999). P e r f e c t i o n i s m was a salient theme that emerged f r o m the data. T h e theme, P e r f e c t i o n i s m - S t r i v i n g to A t t a i n "Perfect" and the sub-themes, G o a l o f Perfect A n o r e x i a , E x p e c t a t i o n s , and D e t e r m i n a t i o n and F o c u s a l l relate to the participants' e x p e r i e n c e o f p e r f e c t i o n i s m as an aspect o f their eating disorder. P e r f e c t i o n i s m was c o n c e p t u a l i z e d as f u e l i n g the eating disorder, and was also related to giftedness b y several o f the participants. P e r f e c t i o n i s m extended to w a n t i n g to be the best at h a v i n g an eating d i s o r d e r and to a d e t e r m i n a t i o n to engage i n the eating disorder and restriction o f their intake " p e r f e c t l y " . M u s s e l l , B i n f o r d and F u l k e r s o n (2000) also cite the use o f eating disorders to c o p e w i t h feelings o f i n a d e q u a c y , and negative e m o t i o n a l i t y as r i s k factors for e a t i n g disorders. C o p i n g w i t h feelings o f i n a d e q u a c y m a y relate to the W o r t h l e s s n e s s , L o w - S e l f E s t e e m a n d C r i t i c a l o f S e l f sub-theme m u c h i n the same w a y as l o w self-esteem variables c i t e d i n the gifted and eating d i s o r d e r literature, but m a y also relate to the C o p i n g T h r o u g h E n g a g i n g i n the E a t i n g D i s o r d e r T h e m e . U s i n g a qualitative approach, W i c k s t e e d (2002) e x p l o r e d issues related to c o n t r o l a m o n g those w h o experience eating disorders. She suggested that a l t h o u g h c o n t r o l appears to be a prevalent theme that has been i d e n t i f i e d anecdotally, current literature often fails to address this t o p i c . T h e p e r s o n a l quest for c o n t r o l , f e e l i n g c o n t r o l l e d , b e i n g c o n t r o l l e d b y the  144  eating disorder itself, and controlling and restricting intake, emotions and experience, is substantiated in the Control and Restriction theme.  Interesting and Unexpected Characteristics  of the Data and  Participants  Based on my clinical experience in the eating disorder field, and a review of the literature, the findings included two very unexpected and interesting characteristics. I make no claims about the basis for these characteristics, as my thoughts have little evidence aside from my clinical intuition. Regardless, these points are curious and if nothing else speak to the homogeneity of the participant sample. First, although the selection criteria for participants did not specify what type of eating disorder the participants experienced, all participants described Anorexia Nervosa, which seemed to be exclusively the restricting type. I did not discriminate or select these participants based on this characteristic, nor did I know what kind of eating disorder they had experienced prior to the interview. M y clinical experience, and anecdotal evidence from other eating disorder professionals seems to indicate that adolescents who experience Anorexia Nervosa often also experience symptoms of B u l i m i a Nervosa, or the bingeing and purging type of Anorexia Nervosa, at some point in their recovery or eating disorder experience. Based on their own description, it seems that none of the participants varied in their eating disorder presentation. W h i l e this could be attributed to a lack of detail in describing specific eating or bingeing and purging behaviours, all participants spoke only of the restricting type of Anorexia Nervosa throughout their description of their eating disorder experience.  145  S e c o n d l y , the fact that the majority o f the participants e x p e r i e n c e d s i g n i f i c a n t p h y s i c a l deterioration, to the p o i n t o f r e q u i r i n g h o s p i t a l i z a t i o n , seemed a p a r t i c u l a r l y interesting p o i n t . A l t h o u g h statistics for the p r o p o r t i o n o f eating disorders r e q u i r i n g h o s p i t a l i z a t i o n s are not a v a i l a b l e , i n m y experience few clients w h o e x p e r i e n c e e a t i n g disorders p h y s i c a l l y deteriorate to the p o i n t o f r e q u i r i n g h o s p i t a l i z a t i o n . A l l participants h a d r e c e i v e d e m e r g e n c y m e d i c a l interventions as a result o f their eating d i s o r d e r a n d f i v e o f the s i x w e r e h o s p i t a l i z e d o n one or m o r e o c c a s i o n for a significant length o f t i m e , due to b e i n g m e d i c a l l y c o m p r o m i s e d or at a significant health r i s k because o f their eating disorder. T h r o u g h a b r i e f f o l l o w - u p c o n v e r s a t i o n w i t h the participant w h o was not h o s p i t a l i z e d i n order to v a l i d a t e the situated structure, it has c o m e to m y attention that she too is b e i n g a s k e d to c o n s i d e r inpatient h o s p i t a l treatment at this time.  Implication of the Study and Findings Exploration  of Original Research  Contributions  T h e f i n d i n g s o f the current study o v e r l a p s o m e w h a t w i t h factors that h a v e been m e n t i o n e d i n p r e v i o u s literature s p e c i f i c to gifted adolescents w h o e x p e r i e n c e eating disorders. P r e v i o u s theoretical e x p l o r a t i o n o f this t o p i c has s p e c i f i e d a n u m b e r o f r i s k factors or c o m m o n characteristics a m o n g gifted i n d i v i d u a l s w h o experience eating disorders, a l t h o u g h the depth o f their experience and its qualitative characteristics have been n e g l e c t e d . T h e richness and depth o f the current f i n d i n g s add a u n i q u e and substantial l e v e l o f m e a n i n g to o u r u n d e r s t a n d i n g o f eating disorders, p r o v i d i n g a b r o a d basis f o r further e x p l o r a t i o n and clinical applications.  146  T h e themes that e m e r g e d through this study, and those that were m e n t i o n e d i n p r e v i o u s literature, c a n be addressed p r i m a r i l y through the themes o f P e r f e c t i o n i s m , L o w S e l f - E s t e e m , and P r i o r i t i z a t i o n o f the N e e d s o f Others. H e i g h t e n e d A w a r e n e s s / S e n s i t i v i t y , a sub-theme o f the E x p e r i e n c e o f Giftedness and E a t i n g D i s o r d e r s E x p l i c i t l y C o n n e c t e d theme, is i n d i r e c t l y referred to i n s o m e w a y through the p r e v i o u s literature. C o p i n g t h r o u g h E n g a g i n g i n the E a t i n g D i s o r d e r , W i t h d r a w a l and Isolation, and N o t F i t t i n g , are m e n t i o n e d but not elaborated o n through p r e v i o u s e x a m i n a t i o n s o f this t o p i c . T h i s study offers several o r i g i n a l research c o n t r i b u t i o n s , as m a n y o f the themes have not been addressed i n p r e v i o u s literature. T h e l e v e l o f depth at w h i c h the experience o f an eating d i s o r d e r is d e s c r i b e d also contributes substantially to s i m i l a r themes i d e n t i f i e d i n p r e v i o u s e x p l o r a t i o n s o f this t o p i c . T h e p r o f o u n d sense o f e m o t i o n a l p a i n , self-devaluation, inner t u r m o i l , a n d p r o g r e s s i v e w o r s e n i n g o f the struggle w h i c h o v e r w h e l m s the y o u n g w o m e n as they e x p e r i e n c e an eating disorder reflected i n themes s u c h as. N e g a t i v e A f f e c t , N e g a t i v e S e l f P e r c e p t i o n s , E m o t i o n a l P a i n , and D e t e r i o r a t i o n and O v e r w h e l m e d a n d C o n f l i c t e d , has not been captured p r e v i o u s l y . T h e q u a l i t y o f these feelings cannot be d e s c r i b e d e a s i l y , a l t h o u g h they are central to understanding the experience o f an eating disorder. T h e s e aspects o f the eating d i s o r d e r e x p e r i e n c e s h o u l d be a focus o f c l i n i c a l interventions. T h e e m o t i o n a l struggle a n d p a i n associated w i t h disordered eating requires support and understanding, a n d c a n be captured m o r e f u l l y through the qualitative d e s c r i p t i o n o f such themes. T h e theme, N o t F i t t i n g : Incongruence and A w a r e n e s s o f D i f f e r e n c e s is m e n t i o n e d b y other theorists (e.g. J a c k s o n & Peterson, 2 0 0 3 ) , yet c o p i n g w i t h this element o f e x p e r i e n c e t h r o u g h an eating disorder has not been e x p l o r e d . T h i s theme has particular relevance for e x a m i n i n g the feelings and e m o t i o n a l p a i n o f gifted adolescents, a n d for e v a l u a t i n g the  147  potential r i s k o f m a l a d a p t i v e c o p i n g m e c h a n i s m s , such as an eating d i s o r d e r that m a y result f r o m i n c o n g r u e n c e i n their e n v i r o n m e n t , unmet needs, and awareness o f differences a m o n g others. T h e p a r t i c i p a n t s ' awareness o f a sense o f b e i n g different f r o m others w h o also e x p e r i e n c e an eating disorder has theoretical and c l i n i c a l i m p l i c a t i o n s . T h e theme, C o p i n g t h r o u g h E n g a g i n g i n an E a t i n g D i s o r d e r , has been b r i e f l y d i s c u s s e d p r e v i o u s l y but the p r o f o u n d sense o f p a i n e x p e r i e n c e d i n this process, a n d the i d e n t i f i c a t i o n o f restriction o f intake as a s o l u t i o n to that struggle has not been e x p l o r e d as f u l l y as it is here. T h e e x p l i c i t relationship between giftedness and the e x p e r i e n c e o f an eating disorder, s u b j e c t i v e l y e x p e r i e n c e d b y the participants, is also an o r i g i n a l research c o n t r i b u t i o n . T h e theme E x p e r i e n c e o f Giftedness and E a t i n g D i s o r d e r and/or S t r u g g l e E x p l i c i t l y C o n n e c t e d captures the w a y i n w h i c h the y o u n g w o m e n i d e n t i f y their giftedness, and the characteristics or c o n t r i b u t i n g factors associated w i t h it that e x p l i c i t l y relate to their e x p e r i e n c e o f A n o r e x i a . T h e sub-theme H e i g h t e n e d A w a r e n e s s / S e n s i t i v i t y resonates w i t h m u c h o f the current literature o n the s o c i a l and e m o t i o n a l qualities o f gifted adolescents, a l t h o u g h this study presents m o r e c l e a r l y h o w s u c h heightened awareness m a y present y o u n g i n d i v i d u a l s w i t h challenges o f f e e l i n g the " w e i g h t o f the w o r l d " and the e m o t i o n a l tone o f their e n v i r o n m e n t . P e r f e c t i o n i s m is c e r t a i n l y not a n e w concept i n either eating d i s o r d e r or gifted research, yet the u n i q u e w a y i n w h i c h the participants articulate the l i v e d e x p e r i e n c e o f p e r f e c t i o n i s m , h o w it is related to their eating disorder, giftedness, and the expectations o f themselves or others is o f interest and a u n i q u e c o n t r i b u t i o n . H o w it feels to be c o n s u m e d b y perfectionistic needs or the quest to achieve "Perfect A n o r e x i a " s h o u l d be e x p l o r e d further a m o n g gifted i n d i v i d u a l s .  148  The theme Control and Restriction as it relates to the eating disorder experience is in many ways inevitable, as restriction of intake is a requisite behaviour for the diagnosis of Anorexia Nervosa. The idea of restriction is not new to the eating disorder literature, although the level of depth at which it is currently examined is unique. This study presents the theme of Control and Restriction as it relates to behavioural, emotional, and experiential elements of an eating disorder experience, and explores how restriction of intake is metaphorical for restriction of other aspects of the lives and experiences of the young women. A s Wicksteed (2002) suggested, the theme of control as it applies to the experience of an eating disorder is often referred to anecdotally, but has not been substantiated or explored through research literature. The theme, Control and Restriction, was prevalent throughout the experience of Anorexia for all the participants and was as a primary need fulfilled through their eating disorder experience. The converse side of control, and the irony of becoming controlled by the eating disorder, the means through which control was sought, is discussed. The need to please others is mentioned in previous eating disorder literature and may relate to the current study's sub-theme, Prioritization of the Needs of Others, yet there seems to be a qualitative difference in the way this sub-theme has been mentioned previously. Prioritizing the needs of others is less about pleasing others, than it is about sacrifice of personal needs, or sacrifice for a greater purpose as described in the theme, Sacrifice, Defiance, and Separation. This theme reveals elements of the experience of an eating disorder that go well beyond a need for validation or to please others. The conceptualization of Anorexia as an act of defiance is articulated by the participants and may be a point of significant clinical relevance.  149  A l t h o u g h p h y s i c a l deterioration and the associated e m o t i o n a l and c o g n i t i v e deterioration that m a y a c c o m p a n y A n o r e x i a is not a u n i q u e f i n d i n g , the severity o f m e d i c a l r i s k a n d h o s p i t a l i z a t i o n that was consistently d e s c r i b e d b y the participants seems u n i q u e . W h e t h e r or not the severity o f the eating disorder experience is m o r e p r o f o u n d a m o n g this p o p u l a t i o n is o f interest a n d warrants i n v e s t i g a t i o n . O n e o f the m o s t interesting f i n d i n g s o f this study was the theme A w a r e n e s s o f M u l t i f a c e t e d U n d e r l y i n g Factors and the sub-theme, E x p e r i e n c e o f E a t i n g D i s o r d e r as N o t A b o u t F o o d . It seems a c o m m o n perception that the search for thinness or p h y s i c a l ideals is a p r i m a r y m o t i v a t i o n for disordered eating a m o n g adolescents. T h e s t u d y ' s participants referred to an u n d e r s t a n d i n g o f the c o m p l e x i t y o f the u n d e r l y i n g d y n a m i c s that c o n t r i b u t e to their eating disorder. T h i s factor alone m a y not be u n i q u e , but the overt reference to b e i n g distressed b y their thinness, or e x p l i c i t l y d e n y i n g thinness as a g o a l , does not appear to be articulated or e x p l o r e d i n current eating disorder literature. T h i s theme m a y also represent a u n i q u e characteristic a m o n g this p o p u l a t i o n that warrants e x p l o r a t i o n , b o t h c l i n i c a l l y a n d t h r o u g h further research. H o w the experience o f an eating disorder relates to i d e n t i t y or m a y represent a means t h r o u g h w h i c h to sever or distance the m i n d - b o d y c o n n e c t i o n also warrants further e x p l o r a t i o n . T h e w a y s i n w h i c h these y o u n g w o m e n attempt to separate their eating d i s o r d e r f r o m their sense o f self, i n order to fight against it, is also o f interest.  Identity  and e x t e r n a l i z a t i o n o f the eating disorder are addressed i n the sub-themes, D e f i n i n g o f S e l f and Identity Issues and E x p e r i e n c e o f E a t i n g D i s o r d e r V o i c e - E x t e r n a l i z a t i o n o f E a t i n g Disorder. F e w w o u l d argue that the experience o f an eating disorder b r i n g s p a i n and suffering to those w h o l i v e the experience. G l o r i f i c a t i o n o f the eating disorder e x p e r i e n c e must be  150  a v o i d e d but the theme, P u r p o s e f u l , A p p r e c i a t e d a n d M e a n i n g f u l E x p e r i e n c e , illustrates the w a y i n w h i c h the participants consistently referred to the m e a n i n g and purpose o f their e x p e r i e n c e and the p o s i t i v e aspects that it has brought to their awareness and l i v e s . T h e n o t i o n o f a necessary struggle, or struggle for a greater purpose also warrants further e x p l o r a t i o n as it relates to gifted p o p u l a t i o n s . T h e participants' clear sense and u n d e r s t a n d i n g o f m e a n i n g and c o n c e p t u l i s a t i o n o f the eating d i s o r d e r as a m e t a p h o r f o r other aspects o f their existence is s t r i k i n g and further e x p l o r a t i o n or c l i n i c a l a p p l i c a t i o n o f that theme has s i g n i f i c a n t importance. M a n y o f the f i n d i n g s o f the current study elaborate on and describe i n r i c h detail the l i v e d e x p e r i e n c e o f p r e v i o u s l y a c k n o w l e d g e d factors associated w i t h eating disorders. O t h e r themes that e m e r g e d f r o m the data are uncharted areas that contribute a s i g n i f i c a n t a m o u n t o f k n o w l e d g e to the current state o f eating disorder k n o w l e d g e as w e l l as gifted literature. T h e w a y s i n w h i c h these u n i q u e c o n t r i b u t i o n c o u l d be a p p l i e d to c l i n i c a l settings and further e x p l o r e d t h r o u g h research are substantial.  Implications For Psychotherapy, Psychoeducation,  and Eating Disorder Treatment  T h e qualitative data and in-depth descriptions o f the l i v e d e x p e r i e n c e o f an eating disorder offer m u c h m o r e than a list o f personality traits or r i s k s factors t y p i c a l l y presented i n current literature. T h e results o f this study a l l o w those w h o choose to read and engage i n the f i n d i n g s to g a i n a c l o s e r p r o x i m i t y to the actual experience o f an eating d i s o r d e r a m o n g gifted adolescents. In d o i n g so, a g l i m p s e into the subjective e x p e r i e n c i n g o f those w h o e x p e r i e n c e the struggle is p r o v i d e d , and it is through that perspective that p s y c h o t h e r a p e u t i c interventions and p s y c h o e d u c a t i o n are most l i k e l y to have an i m p a c t .  151  M u c h o f the r e a s o n i n g b e h i n d this study, a n d the impetus to pursue it, w e r e b a s e d o n a desire to contribute k n o w l e d g e to p r e v i o u s l y neglected area, w h i c h c o u l d then be transferred to c l i n i c a l , a n d p s y c h o e d u c a t i o n a l settings. A s a c l i n i c i a n , a n d s o m e o n e w h o h i g h l y regards the scientist-practitioner m o d e l , the p r a c t i c a l a p p l i c a t i o n o f research f i n d i n g s w a s a p r i m a r y focus. A s the results o f this study relate to gifted adolescents, their c l i n i c a l u t i l i t y w i l l be p r i m a r y related to that p o p u l a t i o n . F o r c l i n i c i a n s w o r k i n g w i t h gifted adolescents e x p e r i e n c i n g eating disorders, h a v i n g g a i n e d further understanding o f research f i n d i n g w i l l p r o v i d e a basis f o r m o r e effective e x p l o r a t i o n w i t h the c l i e n t . B e i n g aware o f h o w the s t u d y ' s f i n d i n g s a n d themes m a y p l a y out o r u n d e r l i e certain thoughts or b e h a v i o u r s m a y p r o v i d e i n s i g h t into the gifted adolescent c l i e n t a n d a means t h r o u g h w h i c h a therapeutic c o n n e c t i o n c a n be made. C l i n i c i a n s i n c o r p o r a t i n g the research f i n d i n g s into their c l i n i c a l w o r k are e n c o u r a g e d to i m m e r s e themselves i n the data a n d rather than search for the w a y that their gifted adolescents clients m a y fit the data, instead take what m a y be o f use a n d i n d i v i d u a l r e l e v a n c e a n d leave the rest b e h i n d . In d o i n g so, the subjective e x p e r i e n c e o f the client m a y be i l l u m i n a t e d through c o m m o n a l i t y w i t h the experience o f others w h o struggle w i t h an eating disorder, but v a l u e d i n a n d o f itself. C l i n i c a l use o f the research findings m a y i n c l u d e either the general structure o r the i n d i v i d u a l situated structures. I n d i v i d u a l participant stories, or the f i n a l themes a n d subthemes c o u l d be e x p l o r e d , i n their entirety, or i n d i v i d u a l l y selected based o n the needs a n d eating d i s o r d e r presentations o f a particular client. S i m p l y a s k i n g h o w s p e c i f i c themes relate to an i n d i v i d u a l ' s experience m a y be b e n e f i c i a l to e x p l o r a t i o n and d e v e l o p i n g a sense o f the c l i e n t . T h e i n d i v i d u a l experiences o f the participants, or the c o m m o n themes m a y resonate  152  w i t h gifted adolescents w h o experience eating disorders, or w i t h their parents. T h e results c o u l d also be i n c o r p o r a t e d into an eating disorder group session as p r o m p t s for e x p l o r a t i o n and d i s c u s s i o n . T h e u n i q u e aspects o f the f i n d i n g s m a y have p a r t i c u l a r r e l e v a n c e to w o r k i n g w i t h gifted clients w h o experience eating disorders, as they represent themes that m a y be less c o m m o n l y e x a m i n e d and p o s s i b l y neglected. F o r e x a m p l e , i d e n t i f y i n g that gifted adolescents m a y not be f o c u s e d o n thinness, m a y be attempting to restrict their e x p e r i e n c i n g i n the w o r l d , to cope w i t h (or restrict) their heightened awareness, that they m a y feel that their e x p e r i e n c e o f an eating disorder experience is v a s t l y different f r o m other y o u n g w o m e n , or m i s u n d e r s t o o d i n treatment settings are a l l areas o f i n q u i r y w h i c h are suggested b y the research f i n d i n g s . I f i n d e e d the f i n d i n g s reflect the y o u n g w o m e n ' s giftedness, then giftedness needs to be e x p l o r e d and nurtured i n psychotherapeutic r e l a t i o n s h i p s , and the f i n d i n g s o f this study p r o v i d e a basis to b e g i n to do so. F r o m a p s y c h o e d u c a t i o n a l perspective, the research f i n d i n g s contribute m u c h i n the same m a n n e r as they w o u l d i n c l i n i c a l settings. C o n s i d e r a t i o n o f the u n i q u e themes that are part o f the e x p e r i e n c e o f an eating disorder a m o n g gifted adolescents is warranted b y those w h o s p e c i a l i z e i n either eating disorder treatment, or p s y c h o t h e r a p y w i t h gifted i n d i v i d u a l s . S u c h professionals m a y also extract p o s s i b l e risk factors f r o m the research f i n d i n g s a n d a p p l y t h e m to preventative or screening considerations. S p e c i f i c a l l y parents o f gifted g i r l s o r y o u n g w o m e n , and m o r e generally, parents o f gifted c h i l d r e n , m a y benefit f r o m an awareness o f the themes and a c l o s e r e x a m i n a t i o n o f what the experience o f an eating d i s o r d e r is r e a l l y l i k e based o n the subjective e x p e r i e n c i n g o f those w h o have been there.  153  T h e f i n d i n g s i n m a n y w a y s reach b e y o n d the e x p e r i e n c e o f A n o r e x i a to i n c l u d e w h a t it is l i k e to experience struggle as a gifted adolescent. T h i s has b r o a d i m p l i c a t i o n s for professionals, researchers and parents, as it applies to gifted adolescents m o r e g e n e r a l l y . A s the participants e x p l i c i t l y relate their giftedness to the e m o t i o n a l p a i n and struggle i n their l i v e s , parents o f a l l gifted c h i l d r e n m a y benefit f r o m an understanding o f an e x a m p l e o f h o w p s y c h o l o g i c a l and gifted issues m a y manifest themselves i n m a l a d a p t i v e w a y s . S i n c e the research f i n d i n g i n m a n y w a y s were g a i n e d as a result o f the p a r t i c i p a n t s ' a b i l i t y to self-reflect and articulate the experience o f an eating d i s o r d e r so t h o r o u g h l y , there m a y also be broader a p p l i c a t i o n to general eating disorder p o p u l a t i o n s . T h e themes that e m e r g e d m a y or m a y not a p p l y to non-gifted p o p u l a t i o n s , but the p o s s i b i l i t y s h o u l d not be o v e r l o o k e d . N o n - g i f t e d adolescents w h o experience eating disorders m a y also benefit f r o m e x a m i n a t i o n o f several o f the themes.  Implications for Future  Research  T h e r e are a m y r i a d o f questions that r e m a i n for m e w h i c h i n v o l v e research questions related to eating disorders a m o n g gifted i n d i v i d u a l s . I continue to have m a n y questions about the broader picture o f eating disorder prevalence and manifestations a m o n g gifted p o p u l a t i o n s , such as whether the prevalence o f this issue a m o n g gifted p o p u l a t i o n is i n d e e d a "serious c o n c e r n " as suggested b y Peterson (1998, p. 197), or whether w i t h o u t appropriate support gifted adolescents w i l l be m o r e prone to " a n x i e t y states, depressive disorder, eating disorders, and o b s e s s i v e - c o m p u l s i v e b e h a v i o r s " as suggested b y J a c k s o n and Peterson ( 2 0 0 3 , p. 177).  154  T h e r e are also further questions that r e m a i n u n a n s w e r e d b y the current study that c o u l d be subsequently e x p l o r e d , u s i n g v a r i o u s research m e t h o d o l o g i e s . B y c o n s i d e r i n g the results as they m a y a p p l y to other p s y c h o l o g i c a l disorders e x p e r i e n c e d b y gifted adolescents, the r o l e o f the themes a n d h o w they relate to giftedness c o u l d also be e x a m i n e d m o r e c o n c r e t e l y . A c o m p a r a t i v e study to i n c l u d e non-gifted adolescents w h o e x p e r i e n c e eating disorders w o u l d also shed light o n the current f i n d i n g s a n d substantiate h o w s p e c i f i c a l l y they relate to giftedness. U s i n g the current research f i n d i n g s as a basis for a m o r e s p e c i f i c i n q u i r y a m o n g gifted adolescents w h o experience eating disorders c o u l d y i e l d m o r e elaborate e x p l o r a t i o n a n d d e s c r i p t i o n o f the current themes. T h e m e t h o d o l o g y u s e d i n this study p r o v i d e d in-depth access to the e x p e r i e n c e o f an eating disorder, but w a s l i m i t i n g i n its u t i l i t y to q u e s t i o n directly. H o w e v e r , this a l l o w e d for a w e a l t h o f i n f o r m a t i o n a n d r i c h descriptions, w h i c h c o u l d be further e x p l o r e d u s i n g the themes as a starting p l a c e to f o r m subsequent research questions s u c h as: H o w does giftedness relate to the experience o f the eating disorders? W h a t parts o f giftedness needed to be addressed i n eating disorder treatment and r e c o v e r y a m o n g this p o p u l a t i o n ? H o w does h e i g h t e n e d s e n s i t i v i t y o r awareness relate to the need to cope t h r o u g h an eating d i s o r d e r ? A l t e r n a t i v e m e t h o d o l o g y that a l l o w s for m o r e structured q u e s t i o n i n g c o u l d extract m o r e specific results a n d a d d to the depth o f the current findings. T h e perspective o f the p r o f e s s i o n a l eating disorder c o m m u n i t y o n this t o p i c , o r response to research f i n d i n g s m a y also warrant i n v e s t i g a t i o n , as the response f r o m professionals t h r o u g h the recruitment process appeared m i x e d . S e v e r a l professionals expressed intense e n t h u s i a s m for e x p l o r a t i o n o f this t o p i c , w h i l e others w e r e not c l e a r as to h o w giftedness m a y p l a y a r o l e i n eating disorders. F e e d b a c k f r o m gifted w o m e n w h o  155  continue to struggle with eating disorders, or who have recovered may also shed light on the relevance of the finding. Follow-up with the participants in the future to reflect on the themes of their experience, or to explore the current state of their psychological state or functioning may also be of interest.  Strengths and Limitations of the Methodology and Study None of the previous literature related specifically to eating disorders among gifted adolescents has been based on empirical research findings, but was instead theoretical in nature, or based on clinical observation. The current study employed rigorous research methodology, and the findings have been validated through participants' feedback and various other means. The depth and breadth of the information gained through this study should add another, valuable dimension to our knowledge of eating disorders among gifted adolescents. Phenomenological interviewing and analysis provided the opportunity to explore the essence of the lived experience of the participants rather than a detached list of characteristics or risk factors. This provides a much clearer sense of what the young women struggling with an eating disorder experience live through and feel, and the meaning of that experience in their lives. It is also important to be mindful of the fact that these women are embedded in a social context and culture that may directly relate to their interpretation of their experiences. The lens of the researcher, through which the data was interpreted, was also susceptible to such influences. The most substantial limitation of this study is the need to consider whether the findings relate to the giftedness of the participants or their advanced abilities to articulate  156  their e x p e r i e n c e . W h e t h e r the f i n d i n g s w i l l generalize to other gifted adolescents is also o f c o n c e r n . T h i s l i m i t a t i o n is a c o n s i d e r a t i o n to be m i n d f u l of, and warrants further e x p l o r a t i o n but does not negate the f i n d i n g s . L i m i t e d i n t e r v i e w contact w i t h the participants is also an i m p o r t a n t p o i n t to c o n s i d e r for t w o reasons. F i r s t , the necessary rapport that m a y have been a requisite for the participants to share their story m a y not have been established f u l l y . T h e r i c h a n d d e t a i l e d i n t e r v i e w s offer e v i d e n c e to the contrary, but it is u n k n o w n whether a different l e v e l o f depth or e x p e r i e n c i n g m a y have e m e r g e d w i t h greater rapport or f a m i l i a r i t y . S e c o n d l y , the s i n g l e i n t e r v i e w m a y have l i m i t e d the amount o f details or the e l a b o r a t i o n o f themes that m a y h a v e been g a i n e d t h r o u g h several i n t e r v i e w s w i t h participants. A g a i n , the richness o f the data is to be c o n s i d e r e d based o n the i n t e r v i e w format used. A f i n a l c o n s i d e r a t i o n relates to whether the f i n d i n g s are s p e c i f i c to the e x p e r i e n c e o f an eating disorder, or m o r e to the experience o f b e i n g a y o u n g gifted w o m a n w h o experiences an eating disorder. C l a r i f i c a t i o n o f this p o i n t i n v o l v e s c o n s i d e r i n g that w h e n p r o m p t e d to tell the story o f their eating disorder, the y o u n g w o m e n n a t u r a l l y e x p l o r e d the s u r r o u n d i n g issues, c o n t r i b u t i n g factors, related e m o t i o n a l states a n d m e a n i n g o f their experience. T h e f i n d i n g s do not p r o v i d e details o f the d a i l y b e h a v i o u r a l o r c o g n i t i v e aspects o f the eating disorder. S e c o n d order reflection, and the themes that w e r e d e r i v e d f r o m those reflections, f o r m the basis o f these research f i n d i n g s .  B y f o c u s i n g o n this l e v e l o f r e f l e c t i o n ,  the l e v e l o f depth and c o m p l e x i t y at w h i c h the y o u n g w o m e n experience their eating d i s o r d e r was h o n o u r e d . T h e f i n d i n g s represent the participants' subjective e x p e r i e n c e o f an e a t i n g disorder, a p r i o r i t y o f this research endeavor.  157  Researcher's  Subjective  Experience  C o n d u c t i n g this study has been an extraordinary experience, one that has t a k e n a significant a m o u n t o f t i m e , attention, and a steadfast b e l i e f i n its v a l u e . A s I reflect o n m y j o u r n e y t h r o u g h this research project, I have a sense that this is a b e g i n n i n g rather than an e n d p o i n t . I f n o t h i n g else, the things that I have learned, and the w a y s that I h a v e g r o w n as a person and a researcher t h r o u g h this, w i l l r e m a i n w i t h m e . M a n y r e l a t i o n s h i p s a n d interactions w i t h others m a k e strong i m p r e s s i o n s o n y o u . B e i n g i m m e r s e d i n the experiences o f these y o u n g w o m e n , at the l e v e l r e q u i r e d to get to this stage, a l l o w e d m e to interact w i t h their stories o f A n o r e x i a i n a v e r y u n i q u e w a y . I v a l u e m y humanness, embrace f a l l i b i l i t y , and f u l l y a d m i t that I interpret the e x p e r i e n c e o f others and m y e n v i r o n m e n t through m y o w n beliefs and experiences. I d o not t h i n k this is a fault i n a qualitative researcher, s i m p l y an important element to be m i n d f u l o f and to never f a i l to consider. I c h a l l e n g e d m y s e l f to do so i n a w a y that I have not d o n e p r e v i o u s l y , and a m the first to admit I a m not perfect. O n e o f the m o s t c h a l l e n g i n g tasks o f this research was to a l l o w m y s e l f to use a l l m y most effective interpersonal, c o u n s e l l i n g a n d c o m m u n i c a t i o n s k i l l s , but at this same time reflect carefully b a c k o n m y humanness a n d beliefs and h o w they affected each stage o f the project. T h i s reflective p r a c t i c e takes a tremendous amount o f energy and at times was terrifying. M y natural state o f interest a n d c o n n e c t i v i t y w i t h others has t y p i c a l l y l e d m e to g a i n a f a i r l y accurate u n d e r s t a n d i n g o f p e o p l e a n d relationships. T h r o u g h o u t the research process, I often caught m y s e l f w i s h i n g I d i d not possess such insight, w h i c h w o u l d have m a d e the b r a c k e t i n g and d e c l a r a t i o n o f biases and assumptions m u s h less onerous. I was k e e n l y aware o f the p o s s i b i l i t y o f o n l y f i n d i n g i n the data o n l y what I thought m a y emerge. I t h i n k that this a l l o w e d m e to be m o r e honest,  158  r i g o r o u s , and c h a l l e n g i n g towards m y s e l f . I d i d f i n d things that I e x p e c t e d to, but I w a s also pleased to be educated a n d p e r p l e x e d b y what also e m e r g e d f r o m the data. W o r d s are inadequate to describe m y experience o f h a v i n g these y o u n g w o m e n share their story, p a i n , and t r i u m p h s related to a v e r y personal part o f their l i v e s w i t h m e . W o r k i n g w i t h adolescents w h o e x p e r i e n c e eating disorders is not n e w to m e . I a m a c c u s t o m e d to b u i l d i n g rapport w i t h these y o u n g w o m e n , the challenges that this area o f p r a c t i c e b r i n g s , a n d the devastating i m p a c t that eating disorders often have. T h e courage to take one step c l o s e r to b e i n g free f r o m their eating disorder and sharing their p a i n and struggle i n the hopes that they m a y be heard and supported is a r i s k for y o u n g p e o p l e e n g a g i n g i n treatment. O f t e n , f o l l o w i n g a therapy session w i t h a y o u n g w o m a n w h o experiences an eating d i s o r d e r I reflect b a c k o n the intensity and p o w e r o f the therapeutic interaction. M u c h i n that same w a y , I sat w i t h these y o u n g w o m e n w h o c a m e f o r w a r d not to be treated or w i t h the s p e c i f i c agenda o f w o r k i n g t o w a r d their r e c o v e r y , but to assist i n a project that they felt was important, a n d to share their story i n the hopes that it m a y be heard and h e l p someone else. T h e s e y o u n g w o m e n are courageous, g i v i n g , and a testament to the strength that endures struggle. 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( 3 e d . , p p . 8 8 - 9 9 ) . r d  Boston, M A : A l l y n and B a c o n . V o n K a r o l y i , C , R a m o s - F o r d , V . , & G a r d n e r , H . (2003). M u l t i p l e i n t e l l i g e n c e s : A perspective o n giftedness.  I n N . C o l a n g e l o , & G . A . D a v i s ( E d s . ) , Handbook of  gifted education. ( 3 ed., p p . 100-112). B o s t o n , M A : A l l y n a n d B a c o n . r d  W i c k s t e e d , A . (2000). M a n i f e s t a t i o n s o f chaos a n d c o n t r o l i n the life experiences o f i n d i v i d u a l s w i t h eating disorders: E x p l o r a t i o n s through qualitative e m a i l d i s c o u r s e . Feminism and Psychology, 10 (4), 4 7 5 - 4 8 0 .  169  Appendix A D S M I V - R Diagnostic Criteria for Eating Disorders (APA, Diagnostic criteria for 307.1 Anorexia  2000)  Nervosa  A . R e f u s a l to m a i n t a i n b o d y w e i g h t at o r above a m i n i m a l l y n o r m a l w e i g h t f o r age a n d height. B.  Intense fear o f g a i n i n g w e i g h t o r b e c o m i n g fat, e v e n t h o u g h u n d e r w e i g h t .  C . D i s t u r b a n c e s i n the w a y i n w h i c h o n e ' s b o d y w e i g h t o r shape i s e x p e r i e n c e d , u n d u e i n f l u e n c e o f b o d y w e i g h t o r shape o n self-evaluation, o r d e n i a l o f the seriousness o f the current l o w b o d y w e i g h t . D . I n p o s t m e n a r c h e a l females, amenorrhea, i.e. the absence o f at least three c o n s e c u t i v e menstrual cycles.  Specific type: Restricting  Type: d u r i n g the current episode o f A n o r e x i a N e r v o s a , the p e r s o n has n o t  r e g u l a r l y e n g a g e d i n b i n g e - e a t i n g o r p u r g i n g b e h a v i o u r (i.e. s e l f - i n d u c e d v o m i t i n g , o r the m i s u s e o f l a x a t i v e s , diuretics o r enemas) Binge/Eating  Purging type: d u r i n g the current episode o f A n o r e x i a N e r v o s a , the p e r s o n  has r e g u l a r l y engaged i n binge-eating o r p u r g i n g b e h a v i o u r (i.e. s e l f - i n d u c e d v o m i t i n g , o r the m i s u s e o f l a x a t i v e s , diuretics o r enemas)  Diagnostic Criteria for 307.51 Bulimia  Nervosa  A . R e c u r r e n t episodes o f b i n g e eating. A n episode o f b i n g e eating is c h a r a c t e r i z e d b y the f o l l o w i n g : 1) eating, i n a discrete periods o f t i m e (e.g. w i t h i n a n y 2 h o u r p e r i o d ) , a n a m o u n t o f f o o d that is d e f i n i t e l y larger than most p e o p l e w o u l d eat d u r i n g a s i m i l a r p e r i o d o f t i m e and under s i m i l a r c i r c u m s t a n c e s . 2) a sense o f l a c k o f c o n t r o l o v e r eating d u r i n g that episode (i.e. f e e l i n g that one cannot stop eating o r c o n t r o l what o r h o w m u c h o n e is eating.) B . R e c u r r e n t inappropriate c o m p e n s a t o r y b e h a v i o r i n order to prevent w e i g h t g a i n , s u c h as s e l f - i n d u c e d v o m i t i n g ; m i s u s e o f l a x a t i v e s , diuretics, enemas o r other m e d i c a t i o n s ; fasting; o r e x c e s s i v e exercise  170  C . T h e b i n g e eating and inappropriate c o m p e n s a t o r y b e h a v i o r both o c c u r , o n average, at least t w i c e per w e e k for 3 months. D . S e l f e v a l u a t i o n is u n d u l y i n f l u e n c e d b y b o d y shape and w e i g h t . E . T h e disturbance does not o c c u r e x c l u s i v e l y d u r i n g episodes o f A n o r e x i a N e r v o s a  Specific types: Purging type: d u r i n g the current episode o f B u l i m i a N e r v o s a , the person has r e g u l a r l y e n g a g e d i n s e l f - i n d u c e d v o m i t i n g o r the m i s u s e o f l a x a t i v e , diuretics, o r enemas Non-Purging  type: d u r i n g the current episode o f B u l i m i a N e r v o s a , the p e r s o n has  u s e d inappropriate c o m p e n s a t o r y b e h a v i o r such as fasting o r e x c e s s i v e e x e r c i s e , b u t has not r e g u l a r l y e n g a g e d i n s e l f - i n d u c e d v o m i t i n g o r the m i s u s e o f l a x a t i v e , d i u r e t i c s , o r e n e m a  307.50 Eating Disorder Not Otherwise  Specified  T h e E a t i n g D i s o r d e r N o t O t h e r w i s e S p e c i f i e d category is for disorders o f eating that d o not meet the c r i t e r i a for any s p e c i f i c eating disorder. E x a m p l e s i n c l u d e : 1.  F o r females, a l l the c r i t e r i a for A n o r e x i a N e r v o s a are met e x c e p t that the i n d i v i d u a l has regular menses.  2.  A l l the c r i t e r i a for A n o r e x i a N e r v o s a are met except that, despite significant w e i g h t loss the i n d i v i d u a l ' s current w e i g h t i s i n the n o r m a l range.  3.  A l l the c r i t e r i a for B u l i m i a N e r v o s a are met except that the b i n g e eating and inappropriate c o m p e n s a t o r y m e c h a n i s m s o c c u r at a frequency o f less than t w i c e per w e e k o r for a d u r a t i o n o f less than 3 months.  4.  T h e regular use o f inappropriate c o m p e n s a t o r y b e h a v i o r s b y an i n d i v i d u a l o f n o r m a l b o d y w e i g h t after eating s m a l l amounts o f f o o d (e.g. s e l f - i n d u c e d v o m i t i n g after the c o n s u m p t i o n o f t w o c o o k i e s ) .  5.  R e p e a t e d l y c h e w i n g and spitting out, but not s w a l l o w i n g , large amounts o f f o o d .  171 Appendix B Interview Protocol and Example Interview Questions Project: A Phenomenological Inquiry of the Experience of Disordered Eating A m o n g Gifted Female Adolescents. To be read to participant: The purpose of this qualitative study w i l l be to provide an in-depth description of the lived experience, common themes and meaning of disordered eating among gifted adolescents. A phenomenological study using in-depth interviews w i l l allow me (the student researcher) to better understand and describe the perceptions and experience of the participants and look for the meaning you ascribe to this phenomenon. These data w i l l be used to explore and describe your lived experience and the lived experience of other participants. It is important for you to know that recounting your experience of disordered eating and the associated emotions may be difficult and should you need to stop or take a break at any time please do not hesitate to do so.  Sample Interview Questions: • • • • • •  Can you share with me the story of your experience with disordered eating? Can you think back to a time before you experienced disordered eating and take me through that time to the present? Can you run through what a typical day was like for you? Prior to experiencing disordered eating what was going on in your life and for you as a young woman? What is the meaning and emotions related to the experience of disordered which you are describing? Is there anything else that you want to add to help me understand your experience?  172  Participants w i l l be encouraged to articulate their experience in relation to felt time, relationship, space and body (i.e. to their environment at home, at school, with friends and family).  Possible prompts for further exploration: • • • • • •  .... sounds important to you. Can you tell me more about that? What is the meaning of that for you? What were/are the emotions and feelings related to the experience you are describing? Can you give me an example of... ? Y o u haven't talked much about... .can you tell me how that fits into your experience? I seem to see a link between.. .and .... H o w does that fit your experience? Can you describe for me the meaning associated with the topic you are discussing?  After completion of the interview some time w i l l be taken to debrief the participant about how they are feeling after having shared their experience. (Thank individual for participating in the interview. Assurance of confidentiality of responses and scheduling of future interview.)  176  Appendix F Adolescent Subject Consent/Assent Form Title of Study: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents Alison Bell, a M a s t e r ' s l e v e l graduate student i n the department o f C o u n s e l l i n g P s y c h o l o g y at the U n i v e r s i t y o f B r i t i s h C o l u m b i a , is u n d e r t a k i n g this project as research for a graduate thesis. P r i n c i p a l Investigator: R i c h a r d Y o u n g E D . D . D e p a r t m e n t o f E d u c a t i o n a l , C o u n s e l l i n g Psychology and Special Education, The University o f British C o l u m b i a . T h e purpose o f this study is to p r o v i d e an in-depth e x p l o r a t i o n and d e s c r i p t i o n o f the c o m m o n themes o f the experience o f disordered eating a m o n g gifted female adolescents (ages 15-18). Y o u have been asked to participate i n this study based o n y o u r selfi d e n t i f i c a t i o n as fitting the advertised c r i t e r i a or b y r e s p o n d i n g to a letter o f contact g i v e n to y o u b y a t h i r d party. In d o i n g so y o u have i d e n t i f i e d y o u r s e l f as an i n d i v i d u a l w h o as an adolescent (age 15-18) e x p e r i e n c e s / e x p e r i e n c e d d i s o r d e r e d eating and h a v e been c l a s s i f i e d as gifted t h r o u g h p a r t i c i p a t i o n i n a gifted p r o g r a m at s c h o o l , assessment f r o m a p r o f e s s i o n a l w i t h expertise i n gifted psychotherapy, or I Q testing w h i c h y i e l d e d results o f 130 or above. L e g a l l y y o u are c o n s i d e r e d a m i n o r w h i l e under the age o f 19. F o r this reason a parent/legal g u a r d i a n must also p r o v i d e consent for y o u r p a r t i c i p a t i o n i n this study. B e c a u s e it is reasonable to assume that y o u are able to understand and m a k e d e c i s i o n s about y o u o w n p a r t i c i p a t i o n y o u must also p r o v i d e assent to participate.  B y p r o v i d i n g assent this means  that y o u agree w i t h the d e c i s i o n o f y o u r parent/guardian to p r o v i d e consent for p a r t i c i p a t i o n . T h e study w i l l i n v o l v e a p p r o x i m a t e l y 6-10 participants w h o w i l l engage i n an in-depth i n t e r v i e w to share their experience o f disordered eating w i t h A l i s o n B e l l . I f y o u agree to participate the i n i t i a l i n t e r v i e w w i l l last a p p r o x i m a t e l y 1-2 hours. A f t e r the i n t e r v i e w has been t r a n s c r i b e d an a d d i t i o n a l i n t e r v i e w , a p p r o x i m a t e l y 1 hour i n length, w i l l be s c h e d u l e d to go o v e r the transcript w i t h y o u to ensure its accuracy and so that y o u m a y have the o p p o r t u n i t y to a d d any further i n f o r m a t i o n y o u w i s h . A l l i n t e r v i e w s w i l l be a u d i o r e c o r d e d . Y o u r i d e n t i t y and p a r t i c i p a t i o n w i l l be kept strictly c o n f i d e n t i a l . O n l y A l i s o n B e l l and D r . R i c h a r d Y o u n g w i l l have access to y o u r i d e n t i f y i n g i n f o r m a t i o n . A l l i n t e r v i e w transcripts and a u d i o - r e c o r d e d i n t e r v i e w s w i l l be i d e n t i f i e d o n l y b y a code n u m b e r a n d kept i n a l o c k e d f i l i n g cabinet. A n y other i n d i v i d u a l s i n v o l v e d i n the data analysis or t r a n s c r i p t i o n o f data w i l l o n l y i d e n t i f y data f r o m y o u r i n t e r v i e w b y c o d e number. Y o u w i l l not be i d e n t i f i e d b y n a m e i n any reports or presentations o f the c o m p l e t e d study. D a t a stored o n c o m p u t e r files w i l l be accessed o n l y t h r o u g h secured passwords and stored w i t h n o i d e n t i f y i n g i n f o r m a t i o n . C o n s e n t f o r m s w i l l be stored i n a secured f i l i n g cabinet separate f r o m any data c o l l e c t e d .  178  Appendix G Subject Consent Form Title of Study: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents Alison Bell, a M a s t e r ' s l e v e l graduate student i n the department o f C o u n s e l l i n g P s y c h o l o g y at the U n i v e r s i t y o f B r i t i s h C o l u m b i a , is u n d e r t a k i n g this project as research for a graduate thesis. P r i n c i p a l Investigator: R i c h a r d Y o u n g E D . D . D e p a r t m e n t o f E d u c a t i o n a l , C o u n s e l l i n g P s y c h o l o g y and S p e c i a l E d u c a t i o n , T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . T h e purpose o f this study is to p r o v i d e an in-depth e x p l o r a t i o n and d e s c r i p t i o n o f the c o m m o n themes o f the experience o f d i s o r d e r e d eating a m o n g gifted female adolescents (ages 15-18). Y o u have been asked to participate i n this study based o n y o u r self i d e n t i f i c a t i o n as fitting the advertised c r i t e r i a or b y r e s p o n d i n g to a letter o f contact g i v e n to y o u b y a t h i r d party. In d o i n g so y o u have i d e n t i f i e d y o u r s e l f as an i n d i v i d u a l w h o as an adolescent (age 15-18) e x p e r i e n c e s / e x p e r i e n c e d d i s o r d e r e d eating and h a v e been c l a s s i f i e d as gifted t h r o u g h p a r t i c i p a t i o n i n a gifted p r o g r a m at s c h o o l , assessment f r o m a p r o f e s s i o n a l w i t h expertise i n gifted p s y c h o t h e r a p y , or I Q testing w h i c h y i e l d e d results o f 130 or above. T h e study w i l l i n v o l v e a p p r o x i m a t e l y 6-10 participants w h o w i l l engage i n an in-depth i n t e r v i e w to share their experience o f disordered eating w i t h A l i s o n B e l l . I f y o u agree to participate the i n i t i a l i n t e r v i e w w i l l last a p p r o x i m a t e l y 1-2 hours. A f t e r the i n t e r v i e w has been t r a n s c r i b e d an a d d i t i o n a l i n t e r v i e w , a p p r o x i m a t e l y 1 h o u r i n length, w i l l be s c h e d u l e d to go o v e r the transcript w i t h y o u to ensure its accuracy and so that y o u m a y have the o p p o r t u n i t y to a d d any further i n f o r m a t i o n y o u w i s h . A l l i n t e r v i e w s w i l l be a u d i o r e c o r d e d . Y o u r identity and p a r t i c i p a t i o n w i l l be kept strictly c o n f i d e n t i a l . O n l y A l i s o n B e l l and D r . R i c h a r d Y o u n g w i l l have access to y o u r i d e n t i f y i n g i n f o r m a t i o n . A l l i n t e r v i e w transcripts a n d a u d i o - r e c o r d e d i n t e r v i e w s w i l l be i d e n t i f i e d o n l y b y a code n u m b e r and kept i n a l o c k e d f i l i n g cabinet. A n y other i n d i v i d u a l s i n v o l v e d i n the data analysis or t r a n s c r i p t i o n o f data w i l l o n l y i d e n t i f y data f r o m y o u r i n t e r v i e w b y code number. Y o u w i l l not be i d e n t i f i e d b y n a m e i n any reports or presentations o f the c o m p l e t e d study. D a t a stored o n c o m p u t e r files w i l l be accessed o n l y t h r o u g h secured passwords and stored w i t h n o i d e n t i f y i n g i n f o r m a t i o n . C o n s e n t f o r m s w i l l be stored i n a secured f i l i n g cabinet separate f r o m any data c o l l e c t e d . Y o u w i l l receive a s m a l l gift, w i t h an a p p r o x i m a t e v a l u e o f $ 1 5 s h o u l d y o u agree to participate i n this study. S h a r i n g the experience o f disordered eating m a y be an e m o t i o n a l e x p e r i e n c e f o r y o u . S h o u l d y o u e x p e r i e n c e p s y c h o l o g i c a l distress and are currently r e c e i v i n g treatment or p s y c h o t h e r a p y  180  Appendix H Parental Consent Form Title of Study: A Phenomenological Inquiry of the Experience of Disordered Eating Among Gifted Female Adolescents Alison Bell, a M a s t e r ' s l e v e l graduate student i n the department o f C o u n s e l l i n g P s y c h o l o g y at the U n i v e r s i t y o f B r i t i s h C o l u m b i a , is u n d e r t a k i n g this project as research for a graduate thesis. P r i n c i p a l Investigator: R i c h a r d Y o u n g E D . D . D e p a r t m e n t o f E d u c a t i o n a l , C o u n s e l l i n g P s y c h o l o g y and S p e c i a l E d u c a t i o n , T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . T h e purpose o f this study is to p r o v i d e an in-depth e x p l o r a t i o n and d e s c r i p t i o n o f the c o m m o n themes o f the experience o f d i s o r d e r e d eating a m o n g gifted female adolescents (ages 15-18). Y o u r daughter or the m i n o r for w h o m y o u are the l e g a l g u a r d i a n has b e e n a s k e d to participate i n this study based o n self-identification as fitting the advertised c r i t e r i a or b y r e s p o n d i n g to a letter o f contact g i v e n to her b y a t h i r d party. In d o i n g so y o u r daughter or the m i n o r for w h o m y o u are the l e g a l guardian has i d e n t i f i e d h e r s e l f as an i n d i v i d u a l w h o as an adolescent (age 15-18) e x p e r i e n c e s / e x p e r i e n c e d d i s o r d e r e d eating a n d was c l a s s i f i e d as gifted t h r o u g h p a r t i c i p a t i o n i n a gifted p r o g r a m at s c h o o l , assessment f r o m a p r o f e s s i o n a l w i t h expertise i n gifted psychotherapy, or I Q testing w h i c h y i e l d e d results o f 130 or above. T h e study w i l l i n v o l v e a p p r o x i m a t e l y 6-10 participants w h o w i l l engage i n an in-depth i n t e r v i e w to share their experience o f disordered eating w i t h A l i s o n B e l l . P a r t i c i p a t i o n w i l l i n c l u d e the i n i t i a l i n t e r v i e w , w h i c h w i l l last a p p r o x i m a t e l y 1-2 hours. A f t e r the i n t e r v i e w has been transcribed an a d d i t i o n a l i n t e r v i e w , a p p r o x i m a t e l y 1 h o u r i n length, w i l l be s c h e d u l e d to go o v e r the transcript to ensure its a c c u r a c y and so that the participant m a y have the o p p o r t u n i t y to a d d any further i n f o r m a t i o n she w i s h e s . A l l i n t e r v i e w s w i l l be a u d i o r e c o r d e d . P a r t i c i p a n t identity and p a r t i c i p a t i o n w i l l be kept strictly c o n f i d e n t i a l . O n l y A l i s o n B e l l a n d D r . R i c h a r d Y o u n g w i l l have access to i d e n t i f y i n g i n f o r m a t i o n . A l l i n t e r v i e w transcripts and a u d i o - r e c o r d e d i n t e r v i e w s w i l l be i d e n t i f i e d o n l y b y a code n u m b e r and kept i n a l o c k e d f i l i n g cabinet. A n y other i n d i v i d u a l s i n v o l v e d i n the data analysis or t r a n s c r i p t i o n o f data w i l l o n l y identify data f r o m the interview(s) b y c o d e number. Participants w i l l not be i d e n t i f i e d b y n a m e i n any reports or presentations o f the c o m p l e t e d study. D a t a stored o n c o m p u t e r files w i l l be accessed o n l y t h r o u g h secured passwords and stored w i t h n o i d e n t i f y i n g i n f o r m a t i o n . C o n s e n t forms w i l l be stored i n a secured f i l i n g cabinet separate f r o m any data c o l l e c t e d . P a r t i c i p a n t s w i l l receive a s m a l l gift, a p p r o x i m a t e l y $ 1 5 , i n value s h o u l d they participate i n this study.  

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